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Showing posts from 2009
A million bucks a day...

will get you a congressman, and not only that, but a congressman who'll vote against healthcare reform. That's right, insurance companies are now spending that much to derail coverage for the citizenry of this country. A few, like Rep. Slaughter, condemn such obvious bribery, and refuse such lobby money. But almost everyone else has their hand out--actually they probably have both hands out (can you say Senator Lieberman?).

We could have had an expanded Medicare for people 55 (or even 45) years of age and older...except for Joe Lieberman. We could have had a public option...except for Joe Lieberman. This morning I listened to a tape of Lieberman spouting off in September (of this year!) saying how he thought expanded Medicare coverage would be a great idea. Apparently it was a great idea until some insurance companies thought it would eat into their profits. So I guess they rang Joe's doorbell or slipped a nice thick envelope under his door. Presto, …
Tuesday's U.S. News and World Report didn't have a lot of good news for the makers of Tamiflu, that overpriced non-miracle drug that has received so much publicity in the wake of the H1N1 influenza virus.
Here's the link:
http://health.usnews.com/articles/health/healthday/2009/12/08/review-questions-tamiflus-effectiveness.html

The original article about Tamiflu appeared in the British Medical Journal on Wednesday. Here is a snippet:

Based on the data available to them, the authors of the new review concluded they have "no confidence in claims that Tamiflu reduces the risk of complications of influenza in otherwise healthy adults," and said the drug should not be used in routine control of seasonal flu.

The article also notes that Tamiflu hasn't been shown to do much other than reduce the symptoms of flu by...ONE DAY.

Countries around the world have been stockpiling the drug--which by the way is none too cheap--which now appears to be less than miraculous.
CVS in hot water…again!


Seems good old CVS has been at it again, caught red-handed selling those rotten expired drugs to grandma and grandpa. Why those greedy little rascals! Well…
The story is a little more complicated than that. I have no great love for CVS (or Rite Aid or Walgreens or any of those boxy corner chain drugstores), and this is one of the reasons why.
Pharmacy managers have a duty to check for expired products. And I haven’t met one manager in my life (well, maybe one) who did not take their job seriously enough to check for expired medicines.
So why isn’t it being done? Let me think for a second…how many drugs are stocked in a typical pharmacy? One bay in a pharmacy can easily contain a thousand drugs and there can be four or five bays. So, understaffed (and every pharmacy I’ve ever seen has been understaffed) and filling a prescription every minute to two minutes, how can anyone expect expired products to be up to date? Well, guess what. They’re not. Not likely to be fo…
(Sung to “I Dreamed a Dream” from Les Miserable):

There was a time when men were kind
And they all forgave their debtors
And insurance was not needed
When all was done by shaking hands, not needing to be signed…
All transactions done in cash,
Town meetings civil and seated.
There was a time…then it all...was trashed.

I dreamed a drug was well-tested
And offered something new
I dreamed it was low-cost
And not just another me-too.

I dreamed the dream I had when young
When costs were paid in dollar bills;
No forms filled out, no effigies hung;
No need for insurance and other frills.

But the lobbyists come at night.
With their voices soft as moleskin.
The PACs and pol’s keep out of sight
They’ve crossed out Lipitor and Ceftin.

When I was young and unafraid,
I could read a doctor’s writing without specs.
E-scripts simply don’t meet the grade--
Is it Prilosec that’s meant or Phisohex?

I dreamed that copays were all the same
I felt as if in a wonderful trance.
I dreamed the sick could not go broke,
That health care w…
Time magazine (Nov.2) has a recent article of note, "You don't know him but he may be the biggest winner in health-care reform. So who loses?" In it, a particular paragraph caught my eye:
    The Federal Trade Commission (FTC), though, argued in June that giving biologics makers any period of exclusivity at all could actually stifle innovation. Biologics are so much more complex and expensive to produce than traditional drugs that the barriers to would-be "biosimilar" competitors are already high, the FTC said. Giving biologics further protection—particularly the 12 years of exclusivity that the industry wants—would merely encourage firms to tinker with what they have rather than drive them toward "new inventions to address unmet medical needs."
The authors, Karen Tumulty and Michael Scherer, are speaking to the controversy re patent exclusivity on expensive biologics, which will soon comprise a hefty share of the pharmaceutical industry's product …
In the olden days if a Mafioso ratted on somebody he'd get thrown off a bridge or tossed off a rowboat wearing cement shoes. Nowadays nobody's ratting on nobody. And why's that? Because the new mafia has made it darn near impossible to rat anybody out, just because it's all so stinking complicated that hardly anybody knows what's really going on.
But the end game is still the same: kill any bugger that gets in your way or costs you money.
When somebody gets killed every half hour in this country you'd think it might just get noticed. Nah. First you'd have to know the links, how it all fits together. And with a body on the floor who's going to notice the dozen different things that caused it to happen in the first place? Nobody, that's who.
Here, I'll give you an example. Say Johnny Walnuts starts to notice his crew isn't taking in nearly as much as it did last year. So he ups his premiums, say. Things start to look better, but not as much as Jo…
If the pharmacy industry can finally solve the riddle of how to serve a patient's need for personal consultation (now vastly underserved) while demanding more and more of the pharmacist's time, then we will enter the next stage of medication management.
As I wrote earlier, robot dispensing of medications holds great promise to free up the pharmacist to actually do what he/she is trained for: medication management (known in the biz as MTM, short for Medication Therapy Management ), inoculations, and training patients to better manage their disease states.
It is amazing that students spend six years in training for disease and medication management but when introduced to the business world none of what the newly graduated can offer is actually used.
Can pharmacists reduce the costs of health care by catching provider errors? Yes.
Can pharmacists reduce hospitalizations, and emergency room use through Medication Therapy Management, increasing adherence to medication use? Yes, agai…
I've been wondering lately if retail pharmacy is dead or at least ready for some major triage.
It's not that the local pharmacy is going to go the way of the dinosaur. Pharmacies will never disappear. But I do think they are going to evolve into a different "animal" than what we see on the corner now. I say that because of the different circumstances faced by the retail druggist than existed even just five years ago.
In January of 2006 millions of elderly Americans began prescription coverage with Medicare Part D. This was not only a boon for seniors; it brought increased foot traffic into drug stores. The volume of prescriptions filled sky-rocketed. Then a couple of years later Wal*Mart brought its own brand of insurance reform by instituting their list of $4 medications. In an industry not known for creativity this was an earthquake high on the Richter scale of business practices. It brought price point back to prescription drugs, competition where none had existed…
When did a pharmacy become a part of the fast-food nation? You walk into a pharmacy with your prescription in hand, present it to the technician or pharmacist, and start to walk away, confident that in a few minutes you will have your medicine and begin your life anew.
When did that happen? I started in this business in 1983. At that time I remember this same expectation of quick, efficient dispensing, though I also remember that a busy pharmacy back then did about 100 prescriptions a day. We were still typing labels, though a few envelope-stretching chains and independents did have computers. So if we did ten Rx's an hour that was a busy. That works out to be one Rx every 6 minutes. Nowadays we do one Rx every minute or two. (That doesn't mean you get your prescription in two minutes; it's more likely to be an hour as the volume has sky-rocketed.)
But back in the Jurassic period of pharmacy, independents used to fill prescriptions in a back room, beyond the view of customer…
Since everyone else and their pet dog gets to sound off on what is the best plan to overhaul the United States healthcare system, I thought I'd put forth a few of my own.
(Note: anyone who has been following this blog knows my reasons for advocating a single-payer system, so the following remarks are meant to be as an alternate to that most desired of solutions.)
Lacking any real reform, which indeed seems now to be the resultant predicament we find ourselves in, we could save millions just by having one uniform billing form, and one uniform insurance card. I have seen insurance cards without any ID number, group number, processor number, or even a logo to let us know whom to bill. Honest.
Give pharmacists the power of therapeutic substitution. If your insurance wants you on Prilosec OTC instead of Aciphex I could switch you to that drug without having to fax or call the office and wait the three days to hear back from them. They're only going to say switch it anyway.
Advocate t…
or not to err, that is the question.
Lately I've noticed interesting reactions from patients when something unusual is noticed with their prescription. Let's say someone receives a prescription for a quantity that they did not expect. Joe Schmoe gets some Zantac 150mg, and takes it twice a day. He looks at the bottle before he leaves and sees that it is for sixty tablets. He points out, none too courteously, I might add, that we've made a mistake. He had asked for a ninety day supply. We should have given him a quantity of #180.
Note: We've made a mistake. Us. The pharmacy team. The druggist. The stoopnagle with the white jacket who can't count. You know the guy, the one who can't read the prescriptions with the silly handwriting on them.
Except that guy didn't make that mistake. Didn't make too many others either. This is the guy whose job it is to catch mistakes. That's right. The job of a pharmacist is to catch the mistakes of others. It is not—prin…
As reported in The New York Times today, Sunday Sept. 13th, 2009, Nikki White died not from her lupus but from a horrific health care system that refused to care for her.
Every half hour another person dies from lack of care in this country (National Academy of Sciences).
And there is no outrage.
As Nicholas Kristof writes, every two months as many people die in this country as died in the World Trade Center attack, which resulted in this country spending hundreds of billions of dollars to prevent such an attack from happening again. But we balk at universal health care.
No outrage. Christians sit on their hands. Republicans call the President a liar. Fox News spreads misinformation. And no one cares.
If you care that Nikki White died needlessly, then you need to do something. Fax a congressman, the president. Something. Anything. Why be part of the problem when you could be part of the solution?
in England. Not here in the good old U.S. of A. Here it's $148 for that prescription of a highly popular cholesterol lowering agent.
But, you say, maybe that's just for that particular drug. Nope. Doesn't matter how newfangled a drug is. In England it's $12.
Yeah, but they must have some expensive health care system over there, right? Nope, again. Per person they spend about half what we do in the U.S.
What about the horror stories? The rationing, the death squads? The people in the UK seem quite happy—only 1 in 10 people think there's something deeply wrong with their system. In the U.S. it is 1 in 3 people. And they're right.
Maybe the argument has been high jacked in favor of the insurance industry? Perhaps.
With all the money we're currently spending, you'd think we'd be all as healthy as newborn babes (babes born in England anyway; babes born in the U.S. don't often aren't quite so lucky), but sadly we're not.
So where's all the mone…
It is becoming clear that the U.S. is going to have some form of health care reform this year. Equally clear is the inevitability that this reform package will be lacking in some important aspects. What we're left with might be considered one of those "half empty, half full" sorts of questions.
On some points anything might be considered an improvement over what we currently have. There is near unanimity on the need to cover those without insurance, for instance. That would be a decided improvement. The greatest need right now in this country is the need to provide for those people without the ability to pay for health care. That is job #1, and it looks like we're going to get there.
Unfortunately the packages making their way through Congress are protecting the insurance industry, not the people needing better care at lower costs. So what we might very well have at the end of the day could be similar to what we now have—plus coverage for 47 more million people—at an …
Is Canada the best example of a nation's regard for its citizenry (this side of Great Britain), or is it the bumbling bureaucracy portrayed by FOX News?
Which Canada is the truer picture?
Today, after another stupid encounter with a patient's insurance company (the group number on the card was not actually the group number), I conversed a bit with the rather patient patient. Turns out she's a nurse and has little regard for insurance. She said that she didn't know what the answer is to our predicament in this country. Not being shy about my own particular views I shared with her my own views. The only good answer is single-payer. She said that that might be good, but not if it produced the lines in Canada that her friends see there.
I said that that wasn't due to any single-payer plan, but simply to a lack of doctors. Massachusetts has the same problem now that they've mandated insurance coverage for everyone (except legal immigrants!).
Americans seem to regard the…
So what would you say is the best drug out there now?
What should the criteria be? Low cost. Effective. Easily dosed at once a day. Curative. Likely to be reimbursed by one's insurance, that is, it won't require prior authorization.
Hard to beat Penicillin VK. Inexpensive and curative. But wait. There are so many bugs out there resistant to it that curative is now iffy. And it is dosed at one tablet every six hours. How many times do you remember to take those things every six hours? Thought so.
Prilosec OTC? Often reimbursable by insurance, it is powerful enough to be considered curative. Even if you don't have an insurance that will pay for it it isn't terribly expensive and you can pick it up right off the shelf. Once daily dose, too.
Steering away from strictly OTC drugs though (like Zantac, Pepcid, etc. which are all quite good), what else? Generic Fosamax is a good one: cheap and effective for osteoporosis, the drug is dosed once a week. Curative, though? Well, I wou…

“Is Everybody All Right?”

"Is everybody all right?" These were Bobby Kennedy's last words after being shot by Sirhan Sirhan. Now these words are beginning to resonate with the American people as his brother, ailing from a brain tumor, hopes to finally see his own efforts at championing national health care for everyone come to fruition.
Is everybody all right? Everybody? OK, you, the guy working the union job at the Ford plant in Atlanta. We all know you're fine with it. You got all the bells and whistles. When you step up to the pharmacy counter you don't expect to see any $50 copays. So you're happy. Right? Well maybe you shouldn't be. Maybe you should have a little more concern for those of us who are unemployed. Or working in a small business that doesn't offer health insurance. Or even those of us who have that $50 copay when you get to pay next to squat.
Maybe, just maybe, this isn't about you. Maybe it's about somebody else. Maybe it's about everybody else. …

The Public’s Indifference is the Real Problem

What is currently wrong with the pharmacy/health care picture is still a nonchalance and "so what?" attitude by so many people. Even when it directly concerns people, when they are even pissed off at the insurance companies (which might—Oh My!—go out of business if we have a public plan).
A customer getting some morphine—long term customer, not an addict trying to get a fix—couldn't get the insurance company to go along with the dosing. Had to get a prior authorization. Well, obviously this was needed NOW because the guy was in some serious pain, but he didn't have the $57 to pay for it. He assumed—never assume this people—his insurance company ("his insurance company": Why do we say this like they are a member of our family?) was going to pay for it and he'd have to pay about $5. So he got pissed at me and stormed out.
Later he came back and apologized. I got talking to him, and basically stated that until Obama gets backing from people like him, peopl…

Change? Who needs change?

When the status quo works so well, I mean. That's the impression I get when I visit the government affairs section of APhA, the site for the American Pharmacists Association. On the docket for the Advocacy Agenda is … Single-payer insurance? No. Health care reform of any sort? Nope. How about controlled substance policy and medguide management? Well, of course. You know, the really important things. After all, we need to nip these medguides in the bud. In…the…bud! We're bud nippers at APhA, that's what we are (apologies to Barney Fife).
Why doesn't APhA get it? Not sure. I suppose they might be afraid their members could be on the short end of the stick (again), but if that is so it seems to me that the smart course of action would be to get in on the ground floor and advocate for change that benefits pharmacy. And change is coming, sure as shootin'.
APhA might also like the existing system. Nah. No one likes this system short of the insurance companies.
So what gi…

Toxins everywhere!

Fads come and go, they say, but one that keeps on coming back is the Detox Diet. This is where you take certain herbs, or adjust your diet, or even put pads on the feet—I'm not kidding!—and the body is detoxified, rid of dangerous poisons.
Exactly what are these toxins? The ads don't like to say, but they're dangerous, taking years off our lives, we're told.
The one getting all the attention is called "Master Cleanse." This diet has you drinking about ten glasses of a lemon juice, cayenne pepper, and maple syrup concoction. Expect to spend your next ten days in the bathroom. Essentially you are starving your body, thereby releasing "toxins" from fat cells. What you are really doing is forcing your gut into diarrheal states for ten days. Not a good idea.
Another is the Martha's Vineyard Diet, started by a nurse (so it has to be good for you, right? Wrong.) Here you get to drink a lot of distilled water, protein shakes, vegetable shakes, and a lot…
"Imagine waking up one day and all your medical decisions are made by a central, national board," says one Richard L. Scott, who seems intent on bashing Obama's plan for a health care re-do.
Before we get to Mr. Scott (see New York Times article "Health Critic Brings a Past and a Wallet," Thu, Apr 2, 2009), I'd like you to ponder that sentence. First, waking up at all is a nice thing these days, given the state of care in this country. If you're a pregnant female, a child, or an elderly person, or anyone with a chronic condition such as diabetes, debilitating pain, heart disease, etc, then God help you. Doctors are too busy with insurance issues to care too much for you and your problems. And they are too afraid of you to actually get to the bottom of things. Afraid you'll end up suing them, so they end up testing you for anything, but don't want to say too much, or spend time with you listening. Just test, bill, test, bill.
But let's say you&…

Fox News makes me cringe

Fox News (I'm sorry but saying that always makes me cringe) has a recent piece of propaganda that must have been hot off the Republican National Committee To-Do List press. In its Media Matters for America segment (http://mediamatters.org/items/200903300029) Betsy McCaughey (ex-lieutenant governor of New York) and Martha MacCallum speak on the topic of Natasha Richardson's recent death.
The Republicans are trying to derail Obama's health care reform. They, being bought and paid for shills of the insurance lobby, hope to convince Americans (remember Harry and Louise???) that single-payer health care is the devil's plaything.
Trying to pin the blame of the gifted actresses' death onto the Canadian system, McCaughey invokes the "cost-benefit" analysis innuendo. As if Canadian doctors carry around calculators and clipboards along with their stethoscopes. As one of the commenters on the site remarks,
"I find this "report" appalling on so many le…

CONSERVADEMS DERAILING REFORM

www.thepetitionsite.com/1/conservadems-you-should-be-replaced
Someone I follow on Twitter gave me this site. I think you should read it and sign it. Anyone interested in fair health care for Americans needs to get on board. Here is the petition:

EVAN BAYH (IN) has organized a conservative democratic caucus called CONSERVADEMS specifically organized to oppose several Obama agenda items that we voted FOR him because we hoped they would be … accomplished! There are 15 senators that are willing to admit to being CONSERVADEMS AND 3 OR 4 MORE WHO attend the meetings but refuse to be named.  They actually want to PREVENT HEALTH CARE LEGISLATION FROM PASSING BY MAKING SURE THAT IT IS BROUGHT UP IN A WAY THAT WILL BE SUBJECT TO REPUBLICAN FILIBUSTERING.  They also want to water down the president's climate change legislation and reduce federal spending. 
   Didn't we work, contribute and vote for President Obama and his agenda for a reason?  Now 59 days into his term and they are fast at…
In Bruce Weber's latest book, "As They See 'Em: A Fan's Travels In The Land of Umpires," he wonders a bit at why someone would put himself (note: they are all men) in the position of being routinely spat on, cursed, and hollered at. I realize that I too could have been a baseball umpire. All of us in retail pharmacy, it seems to me, have the requisite training and inherent abilities to be a big league ump.I've had spittle discharged in my general direction as a matter of course. Cursed? Practically every hour of every day. Yelled at? Please. Only the linoleum saves my shoes from being covered in dirt. 
And the comparison does not stop at the abuse. Pharmacists, like umpires, must make split second decisions and then move on, ready for the next. I continue to recall the episode on "I Love Lucy," where Lucille Ball gets a job in a chocolate factory. The chocolates speed down the line faster than she can pick them up. Finally she begins to shove them in…
It all depends on who you talk to.
So I'm filling a prescription for insulin. Simple right? Nope. Not anymore.
The prescription for NPH insulin, an intermediate acting insulin, had been filled and refilled many times for this person. But this time her insurance rejected the claim. Apparently, as the rejection showed on the computer screen, it needed a prior authorization. For those of you not yet aware of this little bug-a-boo, this is when the insurance company says that the doctor needs to make a written statement showing that the treatment is indeed necessary, otherwise the insurance will deny. This is usually encountered for high priced medications new to the market. Usually a drug like Coreg CR or Ambien CR, where the drug maker reformulates to make it last longer but where the real benefit comes to the company making the drug because it gives them another year of patent life. But for insulin? Why would insulin need a prior authorization?
So I call. I get this nice sweet voice o…
Bad bugs the new white meat?

As reported by Nicholas Kristof in The New York Times recently (Sun, Mar 15th, "Pathogens in Our Pork), hog farms are now infected with the dangerous bug known as MRSA (pronounced "Mersa"). As estimated by the University of Minnesota, up to 39 percent of pigs on hog farms harbor the superbugs which are resistant to almost all forms of antibiotics. (More people die from MRSA in the United States than from HIV.)

Why? Same reason as why doc's give out prescriptions to treat viral infections like colds and ear infections: mis-use of antibiotics. As Kristof writes, more antibiotics are given to livestock in North Carolina alone than goes to treat the entire U.S. population.

This is all due to the tremendous leverage that the agribusinesses have on Washington politicoes. The citizenry is being plowed under for the sake of increasing the yield of hog, cow and chicken farmers.

It's as if the Congress is doing as Marie Antoinette, saying instead,…
From Economist.com (Mar 9, 2009, "The view from West Virginia"):

[Obama] insists that Americans who like the health insurance they currently get through their employer can keep it. But Michael Tanner of the Cato Institute, a libertarian think-tank, predicts that government insurance will crowd out private insurance. The government could offer insurance cheaply by dumping part of the cost on future taxpayers, and so crush its private competitors.
If that happens, hospitals will be squeezed. Currently, patients with private insurance cross-subsidise those in government schemes. (A typical hospital enjoys a profit margin of 48% on each privately insured patient and suffers a 44% loss on each patient covered by Medicaid, the government programme for the poor, according to McKinsey, a consultancy.) If that subsidy disappears because there are fewer private patients left to pay it, hospitals will have to cut back. European-style queues may form, the sceptics fret.

Firstly, why would …
What now, Republican?

David Frum in the Mar 7 Newsweek sums up Rush Limbaugh pretty well:
And for the leader of the Republicans? A man who is aggressive and bombastic, cutting and sarcastic, who dismisses the concerned citizens in network news focus groups as "losers." With his private plane and his cigars, his history of drug dependency and his personal bulk, not to mention his tangled marital history, Rush is a walking stereotype of self-indulgence—exactly the image that Barack Obama most wants to affix to our philosophy and our party. And we're cooperating! Those images of crowds of CPACers cheering Rush's every rancorous word—we'll be seeing them rebroadcast for a long time.

Why is that important for a pharmacy blog? Because if you are a Republican, as I am, your party may well be responsible for either sidelining universal health care or watering it down to where the insurance mafia wins what it needs to win for its survival.
As Rush becomes the arbiter of Repu…
We want the best and we want it now!

As The New York Times reported today (A Hurdle for Health Reform: Patients and Their Doctors, Mar 3, 2009), what fundamentally drives the costs in America's health care system is the desire on the part of doctors and patients for the best--meaning the costliest to most--new treatments and medicines. It doesn't matter if the upside is slim to none. Stick a high price on something and a few slick ad pages and Bam! you've got a winner on your hands. Ever check out the number of beta-blockers out there? How about ACE inhibitors? Gazillions and none of them work appreciably better than the first ones out of the block twenty-five, thirty years ago.

The Times cited a 2004 study (published in The American Journal of Public Health) that showed that only 1 in 16,000 people benefited from recent technology as regards their health.

Today I finally convinced someone not to bother with Tamiflu for her daughter. Was I being too harsh? You decide. Her dau…
The return of Harry and Louise?
Remember those ads featuring Harry and Louise, the middle-aged couple worrying over the governments plan for national health care back in '93? Largely credited for destroying Clinton's plan for the country they are back. Last year, during the 2008 Democratic Convention (and the Republican Convention as the Dems paid for the ad to be aired then too--smart!), the two were reprising their role, this time to explain that too many people were "falling through the cracks." Even the lobby--America's Health Insurance Plans--that created those original ads says it wants to play a different role this time (see The New York Times, Sun, Mar 1, 2009, "Liberal Groups Are Flexing New Muscle in Lobby Wars").
Well, good. Maybe Obama has the political momentum to get this done. I do think he has given too much power over the details to congressman. Who do you trust more to deal with this problem, Obama and his policy wonks, or those congres…
Things I'm going to say (or do) when I get old and take a trip to the pharmacy:
"Excuse me, but I don't talk to technicians. Where's the pharmacist!" (Puff out chest here.)
Throw credit card at cashier, preferably landing on the floor necessitating said cashier to bow to me, stating, "I'm sorry, I believe you dropped this."
"How long will this take?" "Half an hour? All you have to do is put some pills in a bottle!"
"OH MY GOODNESS … WHAT IS TAKING SO LONG!?"
"So how much is this with my insurance?" "And for 30?" "Huh. How about 10?" What if I use my discount card instead?" "And for 30?" "Huh. How about 10?"
"Now what do I do? Sign my name? Then what? Press clear? Whoops. There, I've signed again! Press clear?"
"Why does this cost more every time I come here???"
"Why do they pay $10 and I have to pay $50? Huh? Huh?"
Wait until the prescriptio…
"You one of them ... Reds?"

Now let me say from the getgo that the only Red I've loved is of the shrimp variety, especially those found along the gulf. Sweet! I'm no com-you-nist. I belong to the Republican Party, albeit the party of Lincoln, Roosevelt (Teddy) and Taft, not Bush. But I fear I've been labeled one of them Commie lovers on my insistence on a national health care plan.

I will set the generalized scene: Sitting around the living room or at the dinner table, surrounded by fellow church-going folk, I will inevitably bring up my disgust with the current state of health care in this nation. Someone will, in a near whisper, ask me, "But do you think we should have national health care???" The question posed is of course spoken rhetorically. As if no one at the table would dare suppose that this great country of ours would ever, ever stoop to such a low point. Socialized health care? Raising the flag of our fathers they plant firm their feet and cry…
And I thought pharmacies had problems ...

In yesterday's New York Times Michael Kinsley had an article ("You Can't Sell News by the Slice," Tue, Feb 10, 2009) detailing the woes that prevail amongst the newspaper crowd. Seems they lose money on every paper due to paper and ink costs (not to mention employment, rents, health care, etc), and advertising dollars, normally their sweet spot, are spiraling down the toilet. In a previous issue, Walter Isaacson, former managing editor of Time, had advocated "micropayments" on the Web issues of newspapers, allowing a paper to accrue a nickle or dime for a "click" on an article. Kinsley says even that income wouldn't amount to enough to save the papers. Seems they are dinosaurs awaiting extinction where a few will inevitably survive as evolved journalistic forms on the Web.

So why does this concern me? It just strikes me as being parallel to what pharmacy went through a few decades ago, when it allowed in…
A New Year's Resolution ...

to be, yes, less persnickety! But only at work. Looking back at my 25 years behind the bench, I've noticed a tendency to ratchet up the persnickety level a notch or two every year or so. I take that as a character flaw. A man or woman should be able to disassociate him-/ her-self from a disagreeable situation (and we all know retail is chock-full of disagreeable situations) and attempt to treat the person to whom one is talking in a rational and even a charitable way. That is my resolution.

But here, in the blogosphere, I will allow myself the cure of the rant, giving vent to all the combustibles that cross the divide between "them" and "us"!