The Oxycodone Addict

Pharmacists have all heard of the oxycodone addict coming in their pharmacy and demanding their drug of choice at gunpoint. I have been removed from retail for many years but have had the firsthand knowledge through close colleagues and numerous reports of pharmacies no longer stocking oxycontin, oxycodone, and other narcotics frequently sought out by addicts. On Father's Day, this past Sunday, four people died in a corner drugstore.

Raymond Ferguson, 45, a pharmacist opened the store with a teen pharmacy technician, Jennifer Neijia, 17. Jennifer volunteered to work for an adult tech who had kids and wanted to celebrate Father's Day. Two customers were also killed senselessly, 33 year old Jamie Taccetta who was the mother of two daughters and was about to celebrate her own wedding and Bryon Sheffield, 71.

The problem with the addict is that all thought processes change. The drug fiend who massacred four people at the pharmacy coldly executed them one by one at close range before filling a backpack with pills and strolling away.

It is safe to say that the corner pharmacy is definitely a dangerous place to be.

The Ideal Pharmacist

In a perfect medical world, solely by my own opinion, the ideal pharmacist would do a lot more than he/she does now. In fact, what we do now, based on the current education and training, doesn't even TOUCH what we really know. Pharmacology. Pharmacokinetics. We are experts. Physicians know diagnosing... treatment can sometimes be just what is memorized and recited to them by the latest pharmaceutical rep. So here I go... In a perfect medical world, a patient would go to the physician looking to find out what is wrong with them. The physician would run his/her tests, question the patient, and do their normal diagnostic research. Bingo. Diagnosis is given... "high blood pressure." The physician would write down this diagnosis on his pad and then pass the info along (or electronically - hey it's 2011!) to the pharmacist that is also in their office working. The pharmacist would consult with the physician immediately concerning the diagnosis and best possible drug choice based on the patient rather than what the Eli Lilly rep brought last week.

The patient would drive to the retail pharmacy he/she chose based on what is covered or who they prefer and pick up their med.

Why is there a gap in care? Why does a physician diagnose AND prescribe alone?

I've never agreed with this model and never will. Checks and balances folks... checks and balances.

Discuss.

Rite Aid Failure

When will big retail pharmacy chains learn? Rite Aid deserves a slap on the wrist for what it has promised potential customers.

Really Rite-Aid? Really? You've stooped to an all new low trying to compete with CVS and Walgreens. Yes there are reasons that won't qualify a patient for the $5 reward for the pharmacist not complying... but guess who gets to explain to every patient the rules? That's right! Your employee. Way to make working for Rite-Aid to be the worst possible retail company to work for.

Stock is worth less than $1.50.

Instead of making your employees hate you Rite-Aid, how about coming up with something not so dangerous?

I suppose Rite-Aid is imagining most stores do less than 200 rxs/day. Are they hiring more pharmacists to help meet this demand? What steps are put into place to ensure this is something a pharmacist can do SAFELY. So a company whose shareholders have stock at $1.00 a share wants to give away more of their money when the RULE isn't met?

RITE-AID YOU FAIL. You fail on every level. You fail on appearance, professionalism, and ethics.

It won't be long though and Rite-Aid will be off the street for good.

This is Rite-Aid's hail mary pass.

Joe D'Amico the McRunner

Joe D'Amico is combining a couple of things he loved. Running. McDonald's. His diet consists of hot cakes, egg mcmuffin, hamburger, coke, hamburger and fries for dinner. Come on Joe. Oatmeal is an option. Grilled chicken salad. Grilled chicken sandwich. Well and he runs 100 miles a week.

Oh yeah... in about 2.5 hrs. Impressive.

Why am I blogging this? Well I'm impressed for one that he's getting media attention but isn't attempting to make McD's look bad.

And maybe we will have a cheeseburger flavored gel to use mid-race soon!

Women Still Paid Less

You would think in 2011, salaries would be equal in regards to seniority and job performance; however, I just found out through the proverbial grapevine that I am at the bottom of the pay scale with my coworkers. Keep in mind in seniority, I rank somewhere in the middle. How about one study that was just in the news regarding MDs salaries and the disparity between male and female? In fact, the analysis of starting salaries for more than 8,000 physicians found that the pay gap between men and women increased almost fivefold -- from $3,600 in 1999 to $16,819 in 2008. In other words, it isn't improving. The gap is getting bigger.

Who would have thought?

My Response on Why Docs Should Profit

The blog post: "Why Doctors Should Profit From Dispensing Medications" Yes. You did enter dangerous territory in regards to physicians dispensing medications. Immediately as a pharmacist my first thought is the idea of checks and balances going to pot. Even the federal government knows that having three branches of government decreases the chance for one particular party or worse, person, taking over thus changing our whole democracy.

Why do you feel so strong about making things easier for the patient and sacrifice the safety of what is being prescribed? I cannot tell you how many times I've discovered the wrong drug written for a patient. The wrong strength. The wrong frequency.

PHARMACISTS are not just workers at McDonald's filling your order for a number four supersized value meal. We actually are saving lives.

It is quite humorous to me that 90% of your blog post were the reasons why NOT to do it. You answered your own question.

Does your idea include hiring a pharmacist to actually do the job?

I personally would not go to a physician who had this setup. It does scream profit, and better... would insurance companies reimburse you for that $300/day that you are looking for?

Why dangerous? For a number of reasons.

One, physicians still grapple with the perception that it is improper for a physician to make money from the delivery of care from business ventures.

Two, profit-making from prescription writing might induce physicians to write unnecessary prescriptions.

Three, prescriptions for profit might lead to conflict with pharmacists.

Four, Some states prohibit physician office dispensing, and more dispensing might lead to other states prohibiting the practice.

Five, there is also a fear that such a physician business venture carry significant risk relative to government regulation.

Then, there’s the other side of the issue. Writing prescriptions and ordering their refills takes a lot of physicians’ time. It also takes knowledge. It carries some malpractice risk, should the patient suffer an adverse reaction. Dispensing from the office would be convenient for patients. Since 30% of patients never fill their prescriptions, office dispensing is more likely to assure compliance. And prescriptions dispensed at the office are generally significantly less expensive than those filled at the local pharmacy.

I especially like "It also takes knowledge." Really? At first I was thinking this was approaching the concept with the ease of the fast food model in mind. Shouldn't patients at least take a little bit of responsibility for their own healthcare? Some malpractice risk? Look at the pharmacist that is in a jail for making one mistake on filling a chemo for a child who died as a result. Pharmacists carry a lot of risk, and the majority of complaining you hear is because the retail pharmacy model has catered to the patient's ease to make more money and putting patients at higher risk.

I will always stand by the banking model... a quiet environment where you expect to wait patiently with no other distractions like selling beer, cigarettes, food, etc... A pharmacy should be a place where health is FIRST and respect demanded just like in a bank. Doctors' offices are like this too though yes, the phone rings off the hook and people are waiting for long periods of time (I've personally waited 90 minutes before!!!).

I really believe adding the dispensing portion to the physicians' practice will turn it into a very unprofessional madhouse.

Good luck with that.

Dreaming

I would LOVE to hear if you are a pharmacist out there what you would do if you could do it all over again. Would you be a pharmacist? Would you be a physician? I'm super curious. My own journey was a flukey one. I had every intention of going into medicine. My entire childhood was filled with whispers from my over-achieving parents. "You will be a physician." Yes, I sort of failed them, but I'm quite alright with it. When I see tweets about having to tell a patient they have cancer or hearing about my OB missing a lot of days with her kids due to births, I relish in the fact that when I sign off for the day, I've signed off for the DAY. There are exceptions to taking the job home with you - when I was in home health and carried the dreaded black pager - but for the most part, I've enjoyed my six figure salary and even overtime stints where I've made $100/hr. Not too bad. What would YOU be? If you had the opportunity to never have to work pharmacy again... what would you do?

NSAID news

Taking certain painkillers daily for several years carries a small increased risk of heart attack and stroke, research has suggested.  This information was already released to the public awhile back with the news of Vioxx and eventual withdrawal from the market, so it should really be no surprised that other NSAIDs:  naproxen, ibuprofen, diclofenac, celecoxib, etoricoxib, rofecoxib, and meloxicam (among others) pose the same risk. The researchers found the medicine increased the risk of death from stroke or heart attack by between two and four times, compared with placebo.  The report, published in the British Medical Journal, looked at more than 100,000 patients in 31 clinical trials.

Specifically:  31 trials in 116 429 patients with more than 115 000 patient years of follow-up were included. Patients were allocated to naproxen, ibuprofen, diclofenac, celecoxib, etoricoxib, rofecoxib, lumiracoxib, or placebo. Compared with placebo, rofecoxib was associated with the highest risk of myocardial infarction (rate ratio 2.12, 95% credibility interval 1.26 to 3.56), followed by lumiracoxib (2.00, 0.71 to 6.21). Ibuprofen was associated with the highest risk of stroke (3.36, 1.00 to 11.6), followed by diclofenac (2.86, 1.09 to 8.36). Etoricoxib (4.07, 1.23 to 15.7) and diclofenac (3.98, 1.48 to 12.7) were associated with the highest risk of cardiovascular death.

Taking NSAIDs on a regular daily basis can increase heart risk... add that to the widely known turmoil on the GI system itself.  Risk vs. benefit... the usual see-saw game for most medications on the market.

Stroke and Prozac

Stroke victims who took the antidepressant Prozac for three months following the interruption of blood flow to the brain regained more mobility, and showed lower rates of depression, than those given a placebo pill, a new study has found. Of course, just as many other explanations, the clinical efficacy is unknown. The FLAME trial (short for Fluoxetine for Motor Recovery After Acute Ischemic Stroke) holds out an option for patients who do not reach the hospital quickly enough to receive clot-busting medication, and who lose movement or feeling in the during stroke. It found that after three months, subjects who took the antidepressant fluoxetine scored, on average, 10 points better on a 100-point measure of mobility and sensation than similarly affected subjects who took a dummy pill. Study here.

Integrity is Lost in Wakefield

Hypothesis testing and the outcome, all part of the scientific process, shows integrity whether positive OR negative. In the Wakefield study, he focused his attention on 12 children who had been referred to for GI problems. Dr. Wakefield had already been toying with the idea of a connection between bowel problems and the MMR vaccine. At the same time Dr. Wakefield was paid to find out if children who had already had the MMR vaccine and a corresponding decline had a case. Some of these children were in both studies. That in itself is called "conflict of interest." Dr. Wakefield did admit that more research was needed but that he insisted on the MMR being administered individually rather than the 3-in-1 jab. Today, this study has been retracted as an elaborate fraud with Dr. Wakefield vehemently denying such an accusation. The British medical journal BMJ, which published the results of its investigation, concluded Dr. Andrew Wakefield misrepresented or altered the medical histories of all 12 of the patients whose cases formed the basis of the 1998 study - and that there was "no doubt" Wakefield was responsible. The journalist who wrote the BMJ articles said Thursday he believes Wakefield should face criminal charges.

Is this an example of a doctor who wanted recognition and to be the pariah in the medical community for autism OR is this an example of Big Pharma winning out and going on a witch hunt?

Because of this article, I have personally witnessed the attitude toward vaccinations shift from lifesaving to poison even so far as one parent telling me that she would not vaccinate her three children because it was wrong and if I did the same I was a bad parent. Tell that to the parents of the infants, babies, and children who have died since 1998 when Dr. Wakefield's study appeared.

In the prevaccination era, pertussis (ie, whooping cough) was a leading cause of infant death. The number of cases reported had decreased by more than 99% from the 1930s to the 1980s. However, because of many local outbreaks, the number cases reported in the United States increased by more than 2300% between 1976 and 2005, when the recent peak of 25,616 cases were reported.1 The disease is still a significant cause of morbidity and mortality in infants younger than 2 years. Pertussis should be included in the differential diagnosis of protracted cough with cyanosis or vomiting, persistent rhinorrhea, and marked lymphocytosis. (link)

In the prevaccination era, pertussis caused more than 270,000 cases and nearly 10,000 deaths annually. This rate reached a low of 4 reported deaths in the United States in 1982 and has recently risen to an average of about 25 deaths annually, with 39 being reported in 2005.

It's not so much that if you don't vaccinate your child that your child will die. It's that you are now taking advantage of herd immunity. You are taking advantage of a scenerio where most follow the rules and thus pertussis was on the decline. You are saying, "I don't have to vaccinate my child because pertussis isn't here." It is here. You are helping to carry it along. I am grateful for the recent push to booster dTaP in the adult community.

MMR was the focus of the study, though. I did cringe as both my children received the MMR and watched them like a hawk for the next six months wondering if "the light bulb would turn off suddenly." It did not. I do feel relieved that I don't have to worry about mumps. Mumps is back, folks. Ask those who are deaf now how THEY feel about those parents that will not vaccinate their children.

Read this post from back in May. Exactly. I couldn't have written it any better.

Please, for the love of God, stop putting our children at risk. Vaccinate your children. I truly believe that those that don't are negligent.