Posts

Showing posts from 2010

Still dying, still arguing

People are still dying.

Since America has this system whereby profit is the engine for curing disease, many will go bankrupt or simply die.

On the Huffington Post today there is a story of a little blond 5 year-old girl with leukemia, living in Montana. The father is a disabled vet and the mother works as a house cleaner. Once diagnosed, the first bill was larger than what the family makes in one year.

Another family, the Petriekis' family from Indiana, lucked out when Medicaid of Indiana refused treatment because of a bureaucratic snafu (the treatment was labeled "experimental" despite a 73% success rate) but the insurance handling Medicaid claims for that state finally stepped in. A catastrophe narrowly avoided. (One has to wonder if the insurance would have acted if the situation hadn't become widely known.)

The cases go on and on...it is not hard to find them.

Reading the comments on the Huffington Post is instructive, too. People from the U.S. are embarrassed by …

Big Pharma Spins the Science

http://www.huffingtonpost.com/dr-mark-hyman/dangerous-spin-doctors-7-_b_747325.html#

Doctor Mark Hyman's latest blog concerns a hefty topic: How science is disappearing from our major--and still trusted--journals. He reports how French scientists selected the very best double-blind studies in the leading journals over the past year and independently verified if their conclusions were indeed correct. They found that 40% of these studies lied about the conclusions. Here, Dr Hyman writes:

In plain language, 40 percent of the studies we count on to make medical decisions are authored by scientists who act as "spin doctors" distorting medical research to suit personal needs or corporate economic interests. "Spin" can be defined as specific reporting that could distort the interpretation of results and mislead readers. If the conclusions in 40 percent of the papers published in medical journals are being spun toward independent interests, how can we consider the medici…

Need insurance for sick kids? Fuggedaboutit!

I sometimes get looks of puzzlement when I tell people that there is plenty of money out there to support a single-payer healthcare system. But when you look at the amount of money going to support the administration of claims for all the tens of thousands of private plans out there in this country you suddenly see hundreds of billions of dollars.

Rick Ungar writes a blog for Forbes. He recently wrote an article pointing out the recent decision by some big players to pull out of the child insurance business altogether (rather than have to underwrite sick kids). I've posted the link here: http://tinyurl.com/2u2cj7m

At one point he writes:
We can’t have it both ways. If we have an obligation to provide for the health of our children – and we do – and we don’t believe it is right to put this responsibility on the shoulders of the private market, then it falls to the public sector to take care of this obligation.

I know. We can’t afford it. And why should people without sick children be …

A defense of Arizona Governor Jan Brewer and citizen candidates - National conservative | Examiner.com

A defense of Arizona Governor Jan Brewer and citizen candidates - National conservative | Examiner.com

The last line in this little defense is a killer. I read it and just had to put my two cents in. Gov. Brewer's transparent authenticity? But let's delve into the meat of this article first. It boils down to don't judge a book by its cover. That is, TV just cannot adequately portray the substance of policy. So it doesn't matter that Brewer became absent minded in the debate. And I agree. God knows I'd be a basket case in that scenario. No question. And who wouldn't? So I don't have a problem with her embarrassing exhibition.

What I have a problem with is the substance...or lack thereof. The video of her question-and-answer session with the media showed this quite clearly. She was asked point blank about her bogus claim concerning headless bodies found in the Arizona desert. She paused. And paused. Paused some more. Then she just turned and ended the session.…

Physicians know best...but not ex-lieutenant governors

http://www.timesunion.com/opinion/article/Physician-really-does-know-best-617040.php

Betsy McCaughey, Ph.D. (make sure you see that big ol' Ph.D. cause it's real important, though it does happen to be in constitutional history, not anything to do with medicine as letter writer Forrest Gatton point out--cf. http://tinyurl.com/24rjt6v) used to be the lieutenant governor under Pataki during his first term as governor of NY. Remember her? She was the one who insisted on standing up the entire time during Pataki's State of the State speech. You may not also know she was largely responsible for killing the Clinton health plan basing it (falsely, in this writer's opinion: cf. The White House. Analysis of New Republic article on health care reform. Little Rock: William J. Clinton Presidential Library and Museum, January 31, 2004) on a complicated algorithm that highlighted a bewildering bureaucracy. You probably do know her as the author of the so-called "death panel"…

What's your total cholesterol? Who cares?

Caveat: Although after reading this article you may realize there is evidence for questioning the effects of your cholesterol lowering statin drugs, always consult your doctor and have a frank, and open discussion regarding your medication.

So what is your Total Cholesterol? Well, in the article above, Dr. Joseph Mercola makes the case that your total cholesterol number is a "straw man," a number manufactured by, well, manufacturers in order to sell you medication that you probably do not need. The AMA, as the article states in the bottom third of the article:


"Eight of the nine doctors on the panel that developed the new cholesterol guidelines had been making money from the drug companies that manufacture statin cholesterol-lowering drugs."

Dr. Mercola points out that it is the underlying inflammation doing damage to your arteries that is vitally important. The body then makes more cholesterol (by your liver) in the attempt to repair the damage (cholesterol is made t…

First sentences

I am endeavoring to produce a blockbuster, earthshaking, and potentially an academically career-ending theory for literary criticism:

I read the first sentence and judge accordingly.

Witness the following time saving reviews (totally at random):

In the beginning God created the heavens and the earth.—But can He follow that up?

On an exceptionally hot evening early in July a young man came out of the garret in which he lodged in S. Place and walked slowly, as though in hesitation, towards K. Bridge.—Heck of a sentence. I predict great things from this writer, a Mr. Fyodor Dostoyevsky. Note to Hollywood: Don't change that name.

For a long time I used to go to bed early. —Ok, maybe this loses in translation. (Swann's Way by a M. Proust.)

Look at a map that shows the north Pacific Ocean. —Obviously written by a Neanderthal. (The complete Idiot's Guide to American History, 2nd Ed.)

On my right hand there were lines of fishing stakes resembling a mysterious system of half-submerg…

Death By Handwriting--escripts to the rescue!

Death By Handwriting

About five years ago I read in one of my pharmacy journals about a new fangled fix for doctor's bad handwriting (technically known as "cacography" and is responsible for thousands of hospital admissions each year, billions of wasted dollars, and millions of wasted phone calls from pharmacists, so hey, no laughing matter), utilizing e-scripts, or electronically transmitted prescription which are generated on a handheld PDA by the prescriber then transmitted to pharmacies. The process, besides eliminating illegible scripts, had the additional benefit of potentially alerting MD's to possible interactions and drugs that would require prior authorizations by insurance companies before being transmitted. That way, the doctor would know that the Biaxin script he/she wrote for on a Friday night would need to be changed to something else that the patient could actually pick up.

(I personally like Montana's solution, fining a doctor $500 per illegible p…

The march of the generics!

For those wishing to know, there are many medications slated to lose patent life in the next several months. One caveat: once the patent expires, there is often litigation which results in a prolongation of the legal life of the brand. There are several events that may occur that prolong brand exposure, including litigation, patent settlements (manufacturers will agree to discontinue litigation in exchange for some monetary reward--nice, huh), final FDA approval, submissions of citizen petitions on behalf of brand manufacturers to the FDA, and "at risk launches" which means that once a generic is approved the generic manufacturer can go ahead with the generic but risks further litigation with the brand manufacturer.

That being said here's a list of some drugs going off patent:
Skelid
Cardene SR
Iopidine eye drops
Vistide
Combigan eye drops
Androgel
Androderm
Arixtra
Carbatrol
Concerta
Duac
Lovenox
Lybrel
metadate CD
Sanctura
Tarka
Elestat eye drops

(S)news

I grew up watching the news. My family would watch the news--network news, of course, as this was before cable--while having supper. Usually NBC. I remember the peacock logo. For the longest time, into my twenties, I assumed that that was how people knew what was going on in the country and world. The newspaper was delivered as well; my father read it dutifully. I, on the other hand, mainly read the comics and the sports section.

Eventually I came to love the print media, preferring magazines and papers for their more in-depth coverage of events and political analysis. I gave up on TV news. For a good long time.

Lately I've been watching again. More out of curiosity, to see what's being covered. What I've discovered is that there really isn't anything being covered anymore (was there ever?). Every evening there is a run-down of four or five stories, and I do mean stories. These are all feel-good human interest stories, devoid of any analysis of causes or conclusions. To…

The reason why market forces will never work with healthcare

I recently underwent a preventative procedure at a local hospital. I thought it might be instructive to follow it through from start to finish, just to see how the system actually works, or doesn't work, as the case may be.

My visit began with a routine examination at my primary physician. After determining that I just turned 50 he told me that it was time to schedule a colonoscopy. Yikes, I thought, but if it was good--or bad--enough for Katie Couric then I guess I could put up with it too.

So, after giving me the name of a specialist, I called and made an appointment. Pretty simple. He advised me on what was going to happen and why it was important, what to expect and so forth. He gave me a prescription for MoviePrep and I went to the pharmacy. Being a pharmacist myself, I already knew all about the stuff so I just went to pay for it. $50! Yes, the MD had kindly given me a coupon, but that still made the total out to be $30. (Note: one month later I still haven't received the…

Big Oil and Bobby Jindal (cont.)

Continuing my rant from yesterday's post re Bobby Jindal's utopian air of laissez-faire oil drilling, I'd like to point to the map, specifically to Nigeria. The country, sitting in the middle of the African continent on the crook of the western coastline, is the most populous in Africa. It is rich as well. Rich in oil. Unfortunately is is poor in just about everything else, also mainly due to oil.

From 1970 to 2000, according to Nigerian government estimates, there were 7000 oil spills in the country. One of the most devastating spills has occurred in the Niger Delta, and is at least as large as the Deepwater Horizon disaster now pummeling the Gulf of Mexico.

But in Nigeria there is no camera crew to cover it. No Brian Williams to interview some government hack. There isn't even a Shell Oil executive appearing on TV wearing a look of frustration. There's pretty much nothing, except for a lot of oozing ugly greasy black stuff.

Nigerian light crude--the most desired o…
Tonight I was watching NBC News with Brian Williams interviewing Louisiana Governor Bobby Jindal at the scene of the oil spill. Globs of oil covered the beaches. Brown ooze now blankets the Louisiana coastline, coating pelicans and terns and so forth.

You might expect Jindal to be a tad circumspect regarding future oil rigs bobbing up and down the Gulf. But you would be wrong. Jindal adheres to the Republican platform (full disclosure: this author is a Republican, written with a punctuated embarrassment) of Drill, Baby, Drill! Even now. Even now.

He says, "We shouldn't have to choose between drilling for an energy source like oil and clean beaches." Really? And Avatar wasn't a movie...it was a documentary! And Harry Potter is alive and well somewhere in the Lakeside District of England.

If this disaster hasn't shaken the likes of these Republican oil barons (and their lackeys) into reality from their Utopian dream of clean carbon energy sources, then nothing will…

Brand v. Generic (this time for pets!)

The New York Times has published an article that neatly dovetails with my previous blog entry, the one concerning brand v. generic. It appears that two renowned scientists, a Marion Nestle, the Paulette Goddard professor of nutrition, food studies and public health at New York University, and Malden C. Nesheim, emeritus professor of nutrition at Cornell University, have taken the lion's share of pet food and sifted the remains in order to find out what precisely is in there, and more to the point, what is really the difference between the high end vittles and the low end (published as “Feed Your Pet Right: The Authoritative Guide to Feeding Your Dog and Cat,” published in May by Free Press). You've probably guessed by now about the conclusions. Right. Not much difference. Maybe a prettier package, but all these pet foods come from the same source: human scraps.

So you can spend a lot on your pet and feel all fuzzy good that you are doing your best for good old Max but who--or …

Brand Loyalty and Tylenol

I confess to a slight measure of satisfaction on hearing the FDA is weighing (See? Measure, Weighing...Ahh, metaphorical congruity!) penalties on J & J (Johnson and Johnson). The manufacturer of Tylenol products has been found less than upfront about certain irregularities at its manufacturing plant.

I remember so well trying to convince customers to save a lot simply by buying generic versions of the Tylenol brand products. The generics were often half the price for the same stuff. The vast majority of people, not having money to burn, bought the generics. But once in a while someone would come to the counter and insist on brand only, usually with a huff, saying in effect, I only buy the best!

Well, I thought to myself, I remember that Tylenol poisoning thing going on (though no fault to the manufacturer) about thirty years ago. Didn't seem to hurt people's confidence in the brand. But now, given J & J's current display of quality abandonment, perhaps these people …

Public Option just a matter of time

The Public Option is coming...

It's only a matter of time before the public option in healthcare comes back to the table. Why? Because the insurance company's shenanigans will eventually anger enough people that both Republicans and Democrats will see that it is to their advantage to have it implemented.

The insurance industry has already begun to exploit the loop holes. People between the ages of 55 and 65 will see their premiums triple. Many will not be able to pay their premiums and will have to forgo insurance entirely and pay the penalty. If there was a public option they wouldn't have been able to get away with that (thanks Republicans!).

Think pre-existing conditions went away with this new legislation which outlaws pre-existing conditions? Think again. According to the Huffington Post [http://www.huffingtonpost.com/2010/03/31/insurance-industry-alread_n_519503.html], the companies are allowed "to charge as much as 50 percent more for people who engage in unhealth…

New York's Sugar Tax

New York state, the state I like to call the "Fiscally Challenged State,"--and yes, I know that California is a worthy contender--is contemplating a tax on soda and sugared drinks. The idea is that government can alter the behavior of people, dissuading them from purchasing an unhealthy product. The real reason behind this is of course to bring money into the coffers of the state--New York is facing a 9 to 13 billion dollar deficit (and that's only what they are telling us).

The Times Union newspaper has come out in favor of the tax, saying that the state needs the money and the people need to be told what not to ingest. "Yes, it would be easy to say, just cut spending" posits their recent editorial. Right. But they left one word out: drastically. Just cut spending...drastically.

The problem with New York is not that they don't have enough money coming in. They have plenty. The problem is that they have too much going out. And yes, that means that a lot of p…

Lou, the Proctor & Gamble Guy

I thought I would answer Mr. Lou Pritchett, who wrote A LETTER FROM A Proctor & Gamble Executive TO THE PRESIDENT. For those not familiar with this letter please see my previous post.

Lou,
You are a former soap salesman, which seems at first glance to be a real nice, clean sort of a job, but you scare me more than WWF Smackdown star "Lethal Weapon" Steve Blackman. Why?
You scare me because after just fifteen minutes of Internet fame, hundreds of thousands of people have read your letter. And apparently you really did write this. Most people would have said, Heck no, that must have been some other me.
You scare me because after a day of trying to figure you out I still can't. And I don't know where you went to school.
You scare me because I don't know who paid for you to put that, um, um, stuff out there.
You scare me because I don't know how a simple salesman--and I do mean simple--of soap could rise to become a vice president of Proctor & Gamble...an…

You Scare Me

Had to report this, as it surprised me to no end. I recently received from a friend (yes, I have those), a letter circulated the Web by a certain ex-vice president of Proctor Gamble, a Mr. Lou Pritchett (author of Stop Paddling and Start Rocking the Boat).

After reading the letter I was sure it was fake. These sorts of letters are easy to spot and they are constantly flooding everyone's in-boxes. The style is normally a bit high school, their logic jejune, and they are more than a bit combative.

The letter I speak of exhibits all those traits, but incredibly, at least according to Snopes.com, it is confirmed by the author to be, in fact, from his own hand.

The letter is printed as follows, and I am preparing a persnickety answer and I will post it hence.

AN OPEN LETTER TO PRESIDENT OBAMA

By Lou Pritchett

Dear President Obama:

You are the thirteenth President under whom I have lived and unlike any of the others, you truly scare me.

You scare me because after months of exposure, I know not…

Separation of Church, Politics

Though the gates of Hell shall not prevail against it, the Church is having a tough time.
Although most Americans view themselves as spiritual, they seem less inclined to stand by religion’s banner. In December, a PEW poll showed an increasing likelihood that people identify themselves with New Age beliefs. A recent Newsweek poll showed that nearly 9 of 10 people identify as believing in a higher power. So people still see themselves as spiritual, just not as inclined to join a church.
Something is happening for people to invoke a sense of spiritual need. God still calls to us somehow, but where to?
The Church has one job, given it by Jesus Christ with these words from the Book of Matthew: Therefore go and make disciples of all nations, baptizing them in the name of the Father and of the Son and of the Holy Spirit, and teaching them to obey everything I have commanded you. And surely I am with you always, to the very end of the age.
Note the two parts of this injunction: 1. Make disciple…

Who'd a thunk it? Health Care Debacle Leads to Love!

As reported in The New York Times the awful U.S. healthcare "system" has one shining virtue: It forces people to marry.

Philip Swift wanted to marry his sweetheart, Katie Robbins. But she didn't seem to want the commitment, in a reversal of the normal man-commitment-phobia. Three years went by and Mr. Swift developed kidney stones.

Mr. Swift, like millions of other Americans, doesn't have access to health care. But Ms. Robbins did. Thus:

Katie and Philip
Sittin' in a tree.
M-E-D-I-G-A-P.

The future of pharmacy

Which is better, a store with many registers where you have to guess which line will be faster (think Wal-Mart, Target, grocery stores)or a store where there is but one queue, one line, and where you are directed to a eventual open register (think Best Buy, Marshalls, TJ Maxx, Borders)?

Well, Richard Larson, an engineer at MIT, but also known as Dr. Q--a "queue psychologist"--says that there are definite advantages to the single queue line. Though wait times average the same, anger issues are lessened by the knowledge that there is a definite first-come, first-serve.

There is also an advantage to the store. While Q-ing up, your attention is focused on all the little things up for sale along the way whilst you wait. Nice for impulse buys (always high profit items for stores).

But while Q-ing up at a local Marshals, I thought of another advantage to such a queue: privacy. Here I was waiting for a register with a pair of pants and socks, and I noticed that I was about fifteen o…

Mail Order Prescriptions?

Mail order prescription service is now 6.7% (as of 2008) of all retail prescriptions sold in the U.S. That's 238 million scripts...and growing.

Want to know what happens--and the pitfalls along the way--when filling your prescription through mail-order? Well, follow along.

1) You've got the prescription from your doctor. You need to contact your PBM (that's your Prescription Benefit Manager which you probably think is your insurance but really is a partner with your insurance). The largest PBMs are Express Scripts, Caremark, and Medco. They will send you a form--maybe you already have it--for you to complete and send in along with your prescription. But wait--before you lick that envelope take a good look at that piece of paper. (It would be better to do this at the doctor's office, but if your already home, don't worry.) Looking at the prescription, does it look right to you? Any mistakes? No? Good, but it's a good idea to fill in your address, or better, write …

Speed kills

Ken Lawton of Newfoundland has a point in his blog. It's not necessarily speed that kills, but recklessness. Not merely a fast driver, but a fast, drunk driver. Or a fast impatient impatient driver holding a cup of coffee and talking on his cell phone while driving with is knees. That sort of thing.

The illustration made me think of what happens in pharmacy. It isn't necessarily how fast we fill prescriptions that causes us make errors, but the lack of focus while we are filling at the speed of light. Try filling a prescription every minute or two WHILE answering the phone, counseling a patient, troubleshooting some insurance rejection and answering a technicians question...oh, and the computer just went on the fritz. Great!

That's what leads to errors, and why people end up in the hospital, or in a grave.

Robots can fill ridiculously fast...and accurately. But you start to introduce the human element in there with all that other multitasking stuff...watch out. You're pla…
The Christian Church and Climate Change

Persnickety is branching out...

I began this blog as a way to teach others what pharmacy is really about; it was my intent to show life within the profession to those outside.

I want to branch out now to other ideas, and focus on all the things that it takes to make me persnickety. What riles me, what disgusts, nauseates and sickens me. All of my little pet bete noires that lurk in the shadows of my own particular dark forest.

Up for discussion right now is the prospect of global warming, better known as climate change.

I've been so nauseated recently by the comments of right-wing congressmen who've felt compelled to be ironic now that Washington D.C. has received a couple of snowstorms. "It's going to keep snowing in DC until Al Gore cries 'uncle,'" tweeted Sen. Jim DeMint, R-S.C.

I understand why Republicans are against the idea of climate change. If the science is accurate then businesses are going to have to pony up…
Wait just one sec; I've got to interrupt Newt's fancy schmancy song and dance with this bit of reporting hot off the presses (see Nadja Popovich's piece on NPR.org or http://www.npr.org/blogs/health/2010/02/insurers_post_big_profits_cut.html).

According to documents filed with the U.S. Securities and Exchange Commission, over the last five years the big five health insurance companies' profits have soared to 56 per cent since 2008. That's UnitedHealth Group, Wellpoint, Aetna, Humana, and Cigna. (Aetna was the only one of the five to not post an increase.)

How'd they do that? I mean, especially with the recession and all. Well, according to Avram Goldstein (head of Health Care for America Now, and advocacy group), all they had to do was raise their rates and increase the cost burden for the little guy AND drop 2.7 million sick people who were Oh such a drain on the corporate coffers. So higher premiums, higher copays, made for a nice little "cha-ching".

N…
Newt's Tip #3 of our continuing saga:

• Meet the needs of the chronically ill. Most individuals with chronic diseases want to be in charge of their own care. The mother of an asthmatic child, for example, should have a device at home that measures the child's peak airflow and should be taught when to change his medication, rather than going to the doctor each time.

Having the ability to obtain and manage more health dollars in Health Savings Accounts is a start. A good model for self-management is the Cash and Counseling program for the homebound disabled under Medicaid. Individuals in this program are able to manage their own budgets and hire and fire the people who provide them with custodial services and medical care. Satisfaction rates approach 100%, according to the Robert Wood Johnson Foundation.

We should also encourage health plans to specialize in managing chronic diseases instead of demanding that every plan must be all things to all people. For example, special-needs p…
Continuing our Newt's Greatest Ideas About Healthcare, his second bullet hits close to the mark, kinda:

• Make health insurance portable. The first step toward genuine portability—and the best way of solving the problems of pre-existing conditions—is to change federal policy. Employers should be encouraged to provide employees with insurance that travels with them from job to job and in and out of the labor market. Also, individuals should have the ability to purchase health insurance across state lines. When insurers compete for consumers, prices will fall and quality will improve.

I've put the key words in bold. Making insurance portable has been one of those EUREKA ideas for quite a long time. People lose their jobs and find that they are quite vulnerable to catastrophic illnesses that can bankrupt them. Or worse. What's worse than bankruptcy? How about death? It's well known that every two months as many people die from our so called healthcare mess than died in the …
Continuing our Newt's Greatest Ideas About Healthcare, his second bullet hits close to the mark, kinda:

• Make health insurance portable. The first step toward genuine portability—and the best way of solving the problems of pre-existing conditions—is to change federal policy. Employers should be encouraged to provide employees with insurance that travels with them from job to job and in and out of the labor market. Also, individuals should have the ability to purchase health insurance across state lines. When insurers compete for consumers, prices will fall and quality will improve.

I've put the key words in bold. Making insurance portable has been one of those EUREKA ideas for quite a long time. People lose their jobs and find that they are quite vulnerable to catastrophic illnesses that can bankrupt them. Or worse. What's worse than bankruptcy? How about death? It's well known that every two months as many people die from our so called healthcare mess than died in the …
In todays Opinion (found at http://tinyurl.com/ybltpld) Newt Gingrich has deigned to give us his take on the healthcare debate. Obama said he wanted new ideas, and Newt has some, or thinks he has some. The question is, Are Newt's ideas just more Republican blather? Well, I thought we should look at his list, one item at a time. Here's the first bullet in Newt's gun:

• Make insurance affordable. The current taxation of health insurance is arbitrary and unfair, giving lavish subsidies to some, like those who get Cadillac coverage from their employers, and almost no relief to people who have to buy their own. More equitable tax treatment would lower costs for individuals and families. Many health economists conclude that tax relief for health insurance should be a fixed-dollar amount, independent of the amount of insurance purchased. A step in the right direction would be to give Americans the choice of a generous tax credit or the ability to deduct the value of their health i…
We're being invaded by Canada!

Pretty soon we're going to just have to institute the dreaded National ID card...just so we can lock our ER doors to those pesky neighbors to the north. At least that's the impression given by FOX "News".

“This should be a wake-up call to Congress and the administration,” said a Fox News medical commentator. “It is a fact beyond dispute that the United States remains the global destination for patients from all over the world.” Canadian conservatives weighed in as well. “It’s symbolic,” said Brett Skinner, president of Canada’s right-wing Fraser Institute. “These services are not available at all, or not available on a timely basis here in Canada.”

As Daniel Johnson of Salem-News.com states (in much nicer terms which I feel are lost on FOX) these allegations are lies.

What the FOX liars don't tell you is that the folks who come down south (41,000--if true--are a drop in the bucket of the people being treated in America) are seeki…
What is that you say? Your PPI doesn’t work?

Well, that’s OK, as you are in a lot of company. First, for those of you who don’t know, and still care to know, a PPI is a Proton Pump Inhibitor, like Prilosec, or Omeprazole (Prilosec), or Prilosec OTC (Prilosec again), or Nexium (Prilosec’s active metabolite), or Prevacid, or well, there’s quite a few of them. They are used for GERD (fancy for heartburn) and ulcers.

You might know that the regular dosing of one of these gems is once a day. You know how many times I see a Take one capsule twice a day dosing on a prescription? Lots. Many many times. Why is that?

These drugs though dosed at once a day intervals do not actually have long half lives. Some are quite short, four or five hours. So why do they last so long? Because they bind to an enzyme irreversibly and it takes a while for the body to come back on board. The drugs bind to ACTIVE receptors, which means that timing is crucial: take an hour before eating, so that the drug can bind to…
So you have osteopenia? Now what?

As reported on NPR (go to NPR.org or directly to http://www.npr.org/templates/story/story.php?storyId=121609815),
osteopenia began as a term invented to label test subjects who do NOT have osteoporosis, which is a condition of low bone density. Osteoporosis in the 1990's had just begun to be treated with a new drug by Merck called Fosamax (alendronate). Unfortunately for Merck you needed to have a bone density scan to be properly diagnosed. The scan was expensive and usually not covered under insurance (surprise, surprise). The machines were also expensive and only large medical centers had them. So Merck had this great drug to treat an illness that few would be diagnosed with. What to do?

Well, if you're a fancy schmancy big pharma company you decide, Hey! What was that term used for people who DON'T have osteoporosis? Yeah, that one: Osteopenia. We'll just treat that one! And, we'll buy up a bone density machine maker and Presto! C…
OK, now for something completely different...

For a while now I've gotten off on a tangent, speaking of insurance and political issues. Soapboxing, basically. But I began this blog as a way to let people know what pharmacy is truly about, what it is like being behind the counter, and also to give some hints as to how better to utilize your pharmacy.

So here's one: People want to save money, right? Well, go to http://www.destinationrx.com/
and you can see how much your medication costs in your area. I put in Lisinopril 10mg, for a typical one month supply dosing, just because it is so common. In my area, it turns out I could buy #30 of these babies for anywhere from $3.33 to $20.89. Quite a difference. I imagine the lower tier belongs to one of the supermarket chains competing with Walmart and their $4 list of meds.

These chain discount lists are a wonderful way to save money. (They will tell you that they still make money on these drugs but that's baloney. They are a loss lea…
The Fallen Wounded

Massachusetts has spoken and the rest of us may pay a pretty penny in lives and money for it. With the surprise election of Scott Brown, the Republican nay-sayers now can alter the future of health care in this country. Perhaps it was the fact that Massachusetts already has mandated insurance for its citizens that caused such indifference to the remainder of the country.

It is well documented that a person dies in this country due to private insurance every half hour. We care more about smokers than we do about people who lack insurance…and access to care. Surprisingly that includes the Christian right, despite a clear mandate to “love thy neighbor as thyself.” The “moral majority” seems to have made a pact with the devil and will support anything other than caring for neighbors. The attitude of many of my Christian friends is this: I got mine, all’s right with the world—to heck with you.

Some have the mistaken opinion that health care access is plentiful. Just go int…
The Christian Church and the Lost Opportunity

The Christian Church has but one job, given it by the Lord Jesus Christ with these words:

Therefore go and make disciples of all nations, baptizing them in the name of the Father and of the Son and of the Holy Spirit, and teaching them to obey everything I have commanded you. And surely I am with you always, to the very end of the age. [Matthew 28:19-20]

Ah, but here’s the rub: How exactly do you make disciples? There is the method of the Taliban whereby a military dictatorship is set up and everyone is simply ordered to be religious, whatever that might mean. Then there is the method of inculcation, the preferred means by which moms all over the world bring up their children under the favored instruction of gentle, and ongoing, instruction. A more subtle technique is to simply live as Christ would have us live, and as others see us living in the Spirit as God intended and as God instructed in His Holy Word, then discipleship will be transfer…

Norway cures the superbug!

Norway discovers "cure" for superbugs

Though not technically a cure, as it is not a cidal chemical agent nor some fancy schmancy surgery, Norway has indeed found a way around the problem of the MRSA superbug. First, many may not see this as a huge problem. It is. More people die from MRSA (Methicillin Resistant Staph Aureus) than from AIDS in the U.S. (and 48,000 people die in the U.S. from hospital acquired infections). Across the world, especially in Japan--perhaps the country with the highest reputation for high tech medicine in the world--MRSA costs billions of dollars and hundreds of thousands of lives. So what did Norway do to virtually eliminate the bug in their country?

They banned antibiotics. In all but the most severe cases, doctors do not, even cannot, prescribe antibiotics. Here in the U.S. if you have a cough or some sniffles we hop in our car and see our providers expecting to get a prescription for an antibiotic. And our expectations are thoroughly met. Off we …
Exchange or refund?

This is the season for exchanges and refunds. Presents are returned to the customer service counters across the land and exchanged for other things of different size, different color, or just something altogether different...like cash.

Apparently our political "servants" in Washington, D.C. had this in mind with the recent healthcare bill. The Senate version creates "exchanges" in every single state, whereby we the people can come and shop for health insurance. I have no bone to pick with the idea of mandatory insurance coverage--it's the only way to make the pool of recipients large enough to matter--but let's take a look at what it does to government in general in the country.

Fifty states will have to create fifty new bureaucracies. Now who can say among you out there that that will be a good thing? I live here in the fiscally challenged state of New York, a state that a month ago almost couldn't pay its bills, despite having proper…