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Friday, January 29, 2010

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! Chang-o! We shrink the machine and make it less expensive so that everybody will be able to get a bone density scan.

Now that last part sounds good...until you find out that a scan of the finger or arm doesn't necessarily mean your hip bone is that same density. Basically, Merck funded the ability to treat a non-illness. There is no proof that treating osteopenia lowers fractures...and that's kind of the point isn't it?

That's the power of marketing. That's the power of Big Pharma.

Sunday, January 24, 2010

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 leader, just a way to get you into the store so they can sell you other things.) The problem has always been that each chain has a different list. You would have to go to one pharmacy for this drug and another for that drug. But there are ways around this.

Many times (and I mean many many times)you can find an equal (though not identical) drug in the same drug class on the list and if you speak to your provider (often it just takes a phone call, not an office visit, but if you happen to have an appointment coming up then just broach the topic then) he or she will change to that drug and save you money.

But lets say there isn't another drug equal to yours in that same class. Or say your provider is persnickety (like me) and just says No, take the stuff I wrote for you and that's that. Is there another way to save? Sure. That drug might be on a competing store's list. So many have them nowadays: Target, PriceChopper, Hannaford, Giant Foods, Publix, and of course, Walmart. If you're willing to go and make a separate trip for that med (and know you can get a three month supply which makes the task easier--Walmart now will even mail you meds) you could do that and save. Now, I know what you're thinking: you're a pharmacist and you don't mind telling people to shop multiple pharmacies? Isn't that a dumb thing to do? Don't they always tell patients to stick to one drugstore so they will know what you are on and can check interactions? Well, yes. And that is all true. But did you also know that these computer systems druggists use can have your entire drug profile loaded into them, whether you go to that store or not?

Just tell the druggist--and it's not a bad idea to write the other meds, and otc drugs too, on the back of the Rx. They will load the info into your profile and the system should catch it. If it doesn't (just ask) then go somewhere else--that system is for the birds anyway and you don't want to have anything to do with it. But I've seen enough places to be able to say with confidence that I'd be very surprised--shocked--if any system now available doesn't have the option of having drugs inputted into it.

There. That's the tip of the day for you. Oh, one other thing: give the pharmacist time. Better to leave off a prescription and pick it up the next day if at all possible.

Wednesday, January 20, 2010

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 into a Medicaid office and the government will take care of you (these ideas from the very same minds who abhor “socialist” care). The new Obama-care bill would have raised the family income necessary for Medicaid to $48,000 for a family of four. Sound like a lot of money? Not if you have bills to pay, rent or mortgage, college loans…oh, and medical bills. Some people just don’t want to step into those shoes.

The current situation with regards to health care in the U.S. strikes me as comparable to what we find on the battlefield. We exert tremendous energy to vanquish our foes, but once the battle has ended, we gather up the wounded—both friend and foe. We take our fallen enemies to a hospital and nurse them back to health. The very same people we were trying to kill with a bullet we now attempt to rescue with a bandage.

Here, in this un-Christian country, we blow up—or allow private insurance companies to blow up—individuals, entire families even, until they’ve reached the point—perhaps through bankruptcy or by reaching maximum dollar limits or simply by refusing coverage due to…oh, being sick—reached the point of (you guessed!) of being able to file for Medicaid!! Yeah, we finally get to have insurance…once we are destroyed and forced onto Medicaid!

The kicker is that the people who say just go get Medicaid also like to…yeah, complain about all those people on Medicaid getting a free ride. Gotta love Christian love, don’t you?

The Christian church (see my previous blog on the topic) missed an opportunity big time. They could have worked with those big bad devilish democrats to force out the for-profit insurance companies and said the country: Hey, we hear you. We feel your pain. And we’re going to do something about it.

Coulda woulda shoulda.

Sunday, January 03, 2010


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 transferred as it were by a sort of spiritual modeling.

Our country has had throughout its history seen all three methods. The first can best be exampled by the Salem period and that illustrated by Nathaniel Hawthorne in The Scarlet Letter. The second has always been afforded a chance, but I think especially in the post-world war period when families moved to the suburbs and became a kind of unified Wasp type. The third has current vogue status as the method of choice in a tolerate age, when ringing doorbells to offer up salvation’s message is thought at best gauche and at worst an example of intolerance to one’s right to unbelief.
And so how is the church doing in this age of tolerance and unbelief? It seems not too well. Although the majority of US citizens view themselves as spiritual they seem less and less inclined to stand by the banner of Religion. In the latest ARIS (American Religious Identification Survey) study, the percentage of Americans that see themselves as within a particular denomination decreased by 11% in a generation. But in a Newsweek poll this year nearly 9 out of 10 people identify as believing in a higher power. So people are still seeing themselves as spiritual, just not as inclined to join a church.

This brings me to the matter at hand. In 2009 we saw the Democratic Party take a bull by the horns, in the form of national health care. It was stated by the President that this country needed to fix a problem that was killing a person every half hour and forcing thousands into bankruptcy. Lives were being ruined. Was this the great opportunity for the church to stand up and be noticed, as being a broker for an idea whose time had come? Wouldn’t unbelievers then see that Christians were truly about doing good, showing love, and doing the work of a loving God? But if that were the case the country saw a very different church. The church of the evangelical right became a lapdog for the Republican Party and the blue dog left. It was deemed better to oppose legislation offered up by the Democrats than to work with them to solve a seemingly intractable problem.

What would have happened if the Christian church had stood up for the indigent and became their lobby for the right to have health care? Of course the Catholic Church did indeed do just that, but not the evangelical protestant groups. If they had they would have been given the opportunity not seen since the days of abolition when they worked tirelessly to end the disgrace of slavery. The church had the chance to show the country and the world that it had an agenda of its own, not that of being spoon-fed by the Republican right. And that agenda was that of Jesus Christ, Lord and Savior: Blessed are the meek, the poor, and those long-suffering.
But the church, except for a few isolated examples, stood pat, silent, or worse, shouting the words written for it by conservative talking heads, words that were largely lies.

So instead of reaping the harvest of the great commission, we now have fewer disciples than ever. The church is now perceived by agnostics as a political player, a player alongside large corporate interests and lobbyists, seen as just another secular tile in a game of dominoes.

It could have been so different. But in the end maybe it will work out better. As others see the false charade that is going on in church after church in this country, others will stand out, those walking out into the dark night holding a candle burning brightly, offering shelter to those who need it, giving succor to the poor and sick. This will be the real Church, unconcerned with political gamesmanship and power politics. And the people of the Church will be easy to spot: “by their fruit ye shall recognize them.” Remember that Christ said, "Not everyone who says to me, 'Lord, Lord,' will enter the kingdom of heaven, but only he who does the will of my Father who is in heaven.” My guess is that quite a few Republicans have forgotten that it is Christ’s will that we should seek, and not the Republican Party leadership.

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 go to the pharmacy for our macrolide antibiotics, our penicillin, our tetracycline, our quinolones. But in Norway doctors are not even allowed to prescribe these things, at least not for common ailments. They give out some Tylenol and tell the poor Norwegian to get over it, as he or she will feel better in ten days or so on their own.

Also of note is the ban on drug marketing. Big Pharma is told to stay the heck away from advertising, which led in that country to a decrease in patients asking for this cure and that. Doctors had in the end more control and more information.

Once someone is identified with MRSA in Norway they are isolated and screened for history: who might they have contacted the infection from; whom they might have given it to.

The result has been sensational: the only people who contract MRSA in Norway now are people who have brought it into the country from visits to foreign lands (like the U.S.).

Will these results, as amazing as they are, cause the U.S. to make some changes? Um, I wouldn't bet on it. For one thing, our system is profit driven; pharmaceutical manufacturers would buy any number of politicians to defeat legislation that would curtail antibiotic use in this country. Republican and Blue Dog Democrats would be hollerin' about how we were condemning grandma to an early death (though saving tens of thousands of lives...each year) just so Big Pharma could recoup big profits on Zithromax, Levaquin, Cipro, Omnicef, etc.

So if you happen to be one of the unfortunates diagnosed with MRSA this year, take heart. Glaxo, Merck, Abbott and their pals are going to be doing better on the stock exchange, which is something. Isn't it?
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 property taxes 79% above the national average and being the second most taxed state in the union.

This law will give us another bureaucracy, and more administration waste. Which means more taxes to pay for it. Ah, what a wonderful idea!

I guess they took the idea from private insurance. We have over ten thousand different prescription plans in the U.S. administered by thousands of different companies. Thousands of administrators wasting billions of dollars. It's almost like we are trying our best to come up with a plan to make insurance the most expensive in the world...which it is already.

It could have been so different, so easy, so manageable and efficient. Medicare for all. One insurance, one administrator, one phone number, one formulary, one set of rules. And it would save hundreds of billions of dollars.

Maybe we should all ask for a refund.