Health literacy has been a buzz word in health care for several years now. It is an obvious idea when one thinks about it, but may not be overly apparent. Often we take our intrinsic knowledge for granted, and do not consider that a patient may not have basic reading skills yet alone basic science knowledge.
Because of this in class we talk about open ended questions, talk-back guidelines and reading level of materials. All very valid points, but they all underline a common theme. There is way too much unfiltered information out there for patients now.
Think about it, with the internet and sites like Google, the average patient has ready access to nearly the same medical material that health professionals have. This post does not even consider the large amount of misinformation present. I'm more concerned with the sheer amount of correct and pertinent information related to a patient's health.
Think about it, what if you had immediate access to, say, the building plans of your workplace. The next day you come in and talk to the owner telling them you think this wall should be moved back another five feet or so to give us more room. In looking at the plans, you say it doesn't appear to be doing anything other than partitioning the floor space.
You know what would happen? The owner would laugh his ass off and walk away as you unknowingly want to move a load bearing structure.
Yet this is what we are forced to deal with in health care each day. Patients log on to WebMD or watch Dr. Phil, are presented with information that they do not have the neccessary background to fully understand. They then take this information, come to us and decide to make decisions about their health care without considering our own expertise.
At best it is ludicrous. At worst it is deadly.
I know, I know, you are all screaming. "But a patient has a right to know this information and participate in the management of their health!" And this is true... to a point.
Consider when the negative press about Avandia came to light. One particular patient of ours immediately stopped taking to the medication due to fear of "heart problems." Never mind the fact that the liklihood of this problem was not all that great, we cry wolf far too much in protocols now but that's another discussion, she did not want to die from a heart attack.
The pharmacist looked her straight in the eye and said, "Well you can possibly die from a heart attack or for sure die from diabetes. Your call."
Good for him.
As much as we do not wish to think of our profession in this way, pharmacy is really the management of poisons for positive health purposes. There are side effect whether we like them or not almost solely for this reason.
Many people simply do not understand this part. Life is full of risks, you speed on the freeway to make an appointment or start smoking to look cool with your friends. But when a drug can benefit a patient, but they don't want to take it due to a minor chance of a severe reaction that's okay?
Solutions to this problem can be insanely simple. For instance, when we hand out drug monographs, or when they are posted online, side effects are often listed under categories like 'common' or 'severe'. Dizziness is often listed in the same breath as heart palpitations... but does that mean that the probablity of both are equal? Actually, how often do these side effects occur?
As pharmacists, we know these answers. Patients do not.
So why not add odds of occurrences to all side effect listing? Or perhaps list them in the order of occurrence? I'm sure a few more patients will panic by seeing the exact numbers, but I'm sure many more will have their minds put at ease when they see how rare these 'common' side effects are.
A simple change like that mitigates one of the problems with health literacy and compliance. We have made information a little more digestible and give them a stronger base to make a decision about their health.
We talk about white space and reading level, but not how to relate the information to patients. Honestly, that should be the primary goal of health literacy. It doesn't matter if the material is at a fifth grade level if there is no way for the patient to relate the information in order to make a decision.
And that's ultimately what this is all about, making sure the patient is properly informed so they can make decisions about them selves. We cannot rid the world of WebMD or Oprah, as much as we may want to try, but we can certainly organize the information we give out in a better manner.
Seems simple enough, right?
Showing posts with label Health. Show all posts
Showing posts with label Health. Show all posts
Wednesday, September 14, 2011
Thursday, May 26, 2011
Realistic Professionalism in Health Care Practice
Barely an hour into the first day of orientation for pharmacy school we were given the first, of what would be many, lectures on professionalism. We were told how our daily actions, both during and after work/school, would reflect both the image of the school and of the profession. Due to this, we were to maintain professional decorum at all times.
There was also some insinuation that our actions outside of school could be used as a reason for dismissal.
Think about it though, how realistic is it to expect an individual to maintain professional standards at every waking moment? Am I not allowed to see movies with an R-rating in case a patient sees that I may be viewing something inappropriate? Am I not allowed to consume a beer at a restaurant for fear of a patient judging me?
Where precisely is the line?
For whatever reason, too many people today expect perfection. In the mind of the public, there can be absolutely no errors in dispensing or prescribing or diagnosing without an immense amount of retribution. Life is, of course, immensely precious and people feel wronged when something goes wrong. So-called 'News' shows such as Dateline NBC feed off this fact and help propagate the incessant need for perfection.
However as Alexander Pope once said, "To Err is to be human." We are not machines designed for perfection, we are human beings. We have faults, we make mistakes even though we may strive to mitigate them as much as possible. It's one of the reasons why I repeatedly say here that failure is our greatest strength. Perfection is a wondrous illusion, namely because of the impracticality of it.
Humans, well most humans, cannot restrain their emotions every hour of every day behind a professional facade. In fact, it has been shown in numerous studies that bottling up one's emotions has negative consequences. Health care professionals have one of the most mentally taxing daily jobs, yet we are all expected to maintain professional composure at all times.
Due to this, many choose to vent their frustrations not only for their own mental sanity, but to be able to continue to effectively practice. We all have to let that facade crumble at some point or another, and the majority choose to do so outside of the public realm. Whether it is through a blog, Twitter or even a friend, it is where we are able to let our guard down and shed our concerns, fears and worries.
The evolution of devices like blogs and Twitter may prove to be one of the most beneficial outlets for health professionals in their history. It now only spurs new and creative ideas, but let's professionals bond across state and even national boundaries if only to reassure all that they are not alone in your frustrations. Pharmacy blogs like Your Pharmacist May Hate You and The Angry Pharmacist have quite literally helped to relieve the immense amount of stress felt in pharmacies across the country.
For those of us who may be shy when discussing our most personal problems, professional or otherwise, the fact these devices exist is a godsend.
While those popular blogs exist as a source of venting for the profession, it has lead to the creation of other blogs with slightly different focuses such as Eric, RPh and The Redheaded Pharmacist that exist to help better the profession. And this example is just describing the pharmacy blogosphere, not even considering the countless medical blogs in existence.
Yes, some of these blogs and Twitter accounts are crass, using language that would never be used in an actual professional setting. Yet they speak more truth than any professional document you may see coming out of organizations like APhA or AMA.
Why is this?
Because professionalism is self-limiting in that we are all expected to maintain the same methodologies and persona to standardize patient care. In itself, there is nothing wrong with this, but outside of a professional setting how else are we to spur innovation? How are we to explore the good, and bad, of our profession? How else are we to relieve the stress we all feel and actually enjoy life?
We all carefully consider federal and state laws, often artfully crafting responses to ensure the innocent are protected. Every work place has similar gossip-style discussions, and yet similar health care professional discussions are draped in anonymity in comparison. This is a fact even more impressive when considering the amount of venting we all do.
And venting is just that, an outpouring of frustration. What is said during this time should not be construed as a representative of who they are as a person and a professional. The majority of the time if someone stubs their big toe, their first reaction is to spout off a slew of words that would make a sailor blush. Does this mean that we should judge their response and formulate that they are crass and unprofessional?
Of course not.
Expectations are a wonderful device when used properly, but only when they are based in reality. Today the expectations for not only health care professionals, but for individuals as a whole are unrealistically high. Before you decry what and how they say something, consider the benefits they earn from doing so.
Would you rather have a practitioner who is constantly uptight, concerned with ensuring that they abide by all expectations and standards while they treat you? Or would you rather have the practitioner who is able to release their frustrations outside of work and remains relaxed and clear headed?
Before you judge and before you point fingers remember that you are not speaking about a device spouting off medical advice, but a person with a personality and emotions. They have the same needs and desires as anyone else in the world.
If anything it's a good thing others can see these frustrations under the premise that they realize we are not as infallible as they assume us to be. Because of they see that we are not infallible perhaps, just perhaps, they will no longer operate under the guise of perfection.
One can dream, can they not?
Thursday, December 2, 2010
Taking On Walmart: Lawsuit Style
Over the top post title? Perhaps, but hear me out.
Every one within the pharmacy world agrees that Walmart pharmacies are the cancer of the profession. They are mostly detrimental to the profession, to the point that something needs to be done about it.
In the Walmart I recently worked at, my store manager told me the pharmacy is responsible for 4% of the yearly revenue of the store. Think about that, just 4% of the entire store. In the great scheme of things, the total profit brought in by the pharmacy does not have a high priority. What a pharmacy does accomplish, though, is to drive more people into the store. And that's where the problems arise.
It's not difficult to imagine that twenty years from now we will see the final death blow for true small town, rural, independent pharmacies as the four dollar generic program that Walmart began a few years ago. The effects from this program will begin to become more evident as the years wear on (I personally believe it will, or maybe already has, trickle over to the reimbursement side of things). It's a program which is great for consumers, but utterly terrible for pharmacies and pharmacists.
Previously I have covered how we are routinely underpaid by insurers for the services we provide. Here is how Walmart, in its revenue based mindset, gouges the profession using poor, and unethical, business practices.
In the state I am in at the moment, the average cost of a prescription, prior to the addition of the cost of drug, was $10.28 as of 2006. This is the most recent data we have and does not take into effect the legal changes since then which have significantly increased overhead labor costs. If you consider that the most of the drugs listed under the $4 generic program actually cost roughly $1 per 30-day refill, we're looking at a total cost (in this state) of $11.28 per 30-day supply.
Using a bit of simple math, we can see that Walmart is selling these $4 generics at 64.6% below true cost. Sure they're making a "300%" return on the cost of the drug, but we're a service based profession and you cannot quantify cost in that manner.
Here is where the lawsuit would come into effect; there are laws in place to prevent businesses from undercutting competition by ensuring that they cannot price their products and/or services below a price floor, namely the cost of the product/service. It a byproduct of the monopolistic tendencies of big business at the turn of the 20th century and the anti-trust laws that followed.
This is called predatory pricing, and it is usually intended to drive competition out of business. In Walmart's case, they are doing so to drive more consumers into their store and not so much to rid them of competition.
However, one of the key components of predatory pricing is a high market entry barrier. By pricing their prescriptions so low, and under cost, they are in effect presenting a high market entry barrier. It is one thing for a new, or small, pharmacy to be unable to offer all of the insurance plans offered. It is a completely different problem when they cannot come close matching the cash-pricing policy of Walmart.
Under the Sherman Antitrust Act, this is considered monopolistic business practices and is unhealthy for both the market and the consumer. And, at least legally, you could file a class action lawsuit claiming as such.
The thing is, you would lose the lawsuit. Walmart is far too big, far too powerful and with far too many attorneys. Also, it has proven difficult to adequately argue for monopolistic business practices, although I concede we could develop at least a moderately successful argument.
But here's the best part... we wouldn't have to win the lawsuit.
Really what we need is consumer awareness of what is happening within our profession. It's been shown time and time again, especially when it comes to Walmart, that when the public is presented with an injustice they will move on their own to attempt to right it. People like a good deal, but only to a point.
We have the data, we have the facts, we have the manpower, so why not? What's stopping a group of us from standing up and actually doing this? It isn't about increasing pharmacy profits, about maintaining the integrity of one of the most important health care professions in existence. We an argue convincingly that we have been put on a dangerous path and, if it is not righted, in a few years we will be presented with a very serious problem.
Cost/revenue cannot be the sole driving force for the profession, yet Walmart, and to a lesser extent the other large corporations, have decided to take that route. It will continue to harm us, the market and, ultimately, the patients. The last part of that statement is what we have to proclaim most loudly.
Let's rile up the consumers, let them see how big business is harming one of the essential health care services in this country. It can only go up from here, right?
Every one within the pharmacy world agrees that Walmart pharmacies are the cancer of the profession. They are mostly detrimental to the profession, to the point that something needs to be done about it.
In the Walmart I recently worked at, my store manager told me the pharmacy is responsible for 4% of the yearly revenue of the store. Think about that, just 4% of the entire store. In the great scheme of things, the total profit brought in by the pharmacy does not have a high priority. What a pharmacy does accomplish, though, is to drive more people into the store. And that's where the problems arise.
It's not difficult to imagine that twenty years from now we will see the final death blow for true small town, rural, independent pharmacies as the four dollar generic program that Walmart began a few years ago. The effects from this program will begin to become more evident as the years wear on (I personally believe it will, or maybe already has, trickle over to the reimbursement side of things). It's a program which is great for consumers, but utterly terrible for pharmacies and pharmacists.
Previously I have covered how we are routinely underpaid by insurers for the services we provide. Here is how Walmart, in its revenue based mindset, gouges the profession using poor, and unethical, business practices.
In the state I am in at the moment, the average cost of a prescription, prior to the addition of the cost of drug, was $10.28 as of 2006. This is the most recent data we have and does not take into effect the legal changes since then which have significantly increased overhead labor costs. If you consider that the most of the drugs listed under the $4 generic program actually cost roughly $1 per 30-day refill, we're looking at a total cost (in this state) of $11.28 per 30-day supply.
Using a bit of simple math, we can see that Walmart is selling these $4 generics at 64.6% below true cost. Sure they're making a "300%" return on the cost of the drug, but we're a service based profession and you cannot quantify cost in that manner.
Here is where the lawsuit would come into effect; there are laws in place to prevent businesses from undercutting competition by ensuring that they cannot price their products and/or services below a price floor, namely the cost of the product/service. It a byproduct of the monopolistic tendencies of big business at the turn of the 20th century and the anti-trust laws that followed.
This is called predatory pricing, and it is usually intended to drive competition out of business. In Walmart's case, they are doing so to drive more consumers into their store and not so much to rid them of competition.
However, one of the key components of predatory pricing is a high market entry barrier. By pricing their prescriptions so low, and under cost, they are in effect presenting a high market entry barrier. It is one thing for a new, or small, pharmacy to be unable to offer all of the insurance plans offered. It is a completely different problem when they cannot come close matching the cash-pricing policy of Walmart.
Under the Sherman Antitrust Act, this is considered monopolistic business practices and is unhealthy for both the market and the consumer. And, at least legally, you could file a class action lawsuit claiming as such.
The thing is, you would lose the lawsuit. Walmart is far too big, far too powerful and with far too many attorneys. Also, it has proven difficult to adequately argue for monopolistic business practices, although I concede we could develop at least a moderately successful argument.
But here's the best part... we wouldn't have to win the lawsuit.
Really what we need is consumer awareness of what is happening within our profession. It's been shown time and time again, especially when it comes to Walmart, that when the public is presented with an injustice they will move on their own to attempt to right it. People like a good deal, but only to a point.
We have the data, we have the facts, we have the manpower, so why not? What's stopping a group of us from standing up and actually doing this? It isn't about increasing pharmacy profits, about maintaining the integrity of one of the most important health care professions in existence. We an argue convincingly that we have been put on a dangerous path and, if it is not righted, in a few years we will be presented with a very serious problem.
Cost/revenue cannot be the sole driving force for the profession, yet Walmart, and to a lesser extent the other large corporations, have decided to take that route. It will continue to harm us, the market and, ultimately, the patients. The last part of that statement is what we have to proclaim most loudly.
Let's rile up the consumers, let them see how big business is harming one of the essential health care services in this country. It can only go up from here, right?
Tuesday, November 2, 2010
Health Care Reform
We all struggle to relate complex items, such as the current health care reform, to friends, family and even patients. We were shown this video in class from Kaiser Permanente and found it to be humorous while educational.
I though it best to share it to help defuse the confusion that is so often found when discussing current reform.
I though it best to share it to help defuse the confusion that is so often found when discussing current reform.
Wednesday, September 22, 2010
Hooked on Phonics for Prescribing
Little verbiage from me today other than a collection of some prescriptions I have seen come my way over the past two weeks.
I thought being in a much bigger city would provide at least slightly better prescription writing skills.
I was wrong.
Somewhere, some place, Grumpy is rolling around in his office...
I thought being in a much bigger city would provide at least slightly better prescription writing skills.
I was wrong.
Avelox 40mg/0.4mL
#5
Inject Daily For Five Days
Vytorin 10/40mg
#6
Take 1 tablets as needed prior to sexual intercourse
Lisinopril 20mg
#30
Take 1 tablet. Inject in right eye four times daily for diarrhea
Oxycontin 80mg
#120
Take 1 tablet by mouth four times daily
Refills: PRN
Somewhere, some place, Grumpy is rolling around in his office...
Tuesday, June 15, 2010
Becoming Close With Someone... In a Whole New Way
Ah intimacy. There is nothing better than being intimate with someone else no? Well then, I have just the product for you from Fleet. Have a gander HERE.
Interesting no? Now lets focus on a small portion of the advertisement;
To be honest, I've never heard that phrase used before. I suppose you can be intimate with a sphincter. I am unsure however it is wise to buy it chocolate and flowers.... ok, maybe it doesn't need chocolate.
One has to wonder how hard the marketing department was laughing when first presented with the need to explain this benefit and second when they decided on the terminology.
I mean it just opens up a wealth of opportunities to use this phrase. It has officially entered my daily lexicon.
"Ma'am do you like intimacy.... anal intimacy?"
I hope to all that is holy that someone asks me a question about this product. The bigger question is whether or not I'll be able to keep a straight face when helping them.
I'm betting not. Could you?
Interesting no? Now lets focus on a small portion of the advertisement;
Reasons for elective rectal cleansing include perceived health benefits, or use before or after anal intimacy.Anal intimacy.
To be honest, I've never heard that phrase used before. I suppose you can be intimate with a sphincter. I am unsure however it is wise to buy it chocolate and flowers.... ok, maybe it doesn't need chocolate.
One has to wonder how hard the marketing department was laughing when first presented with the need to explain this benefit and second when they decided on the terminology.
I mean it just opens up a wealth of opportunities to use this phrase. It has officially entered my daily lexicon.
"Ma'am do you like intimacy.... anal intimacy?"
I hope to all that is holy that someone asks me a question about this product. The bigger question is whether or not I'll be able to keep a straight face when helping them.
I'm betting not. Could you?
Friday, April 23, 2010
I Want To Be A PBM.... So I Don't Have To Pay Taxes
I can understand why PBMs reimburse us mere pennies above cost. I can, somewhat understand why they refuse to pay fees.
What I do not understand, however, is why they refuse to pay the tax on a drug.
You see in one of the states I have worked in, I keep tabs on my prior employers, many of the PBMs have decided they will not pay for the state tax on the prescriptions we fill. They leave it 'up to the pharmacies' to deal with as one kind PBM rep told an ex-coworker of mine.
The kicker is according to that particular state law, the PBM has to pay the taxes enforced by the state. Yet some how, they're allowed to get away with not paying it.
They are then left with the tax amount and are forced to make the patient pay for it. It is not something that normally I would condone, but seriously what else can you do?
My question is how is this acceptable? Several of the patients who have asked why this has happened have been completely livid with their provider. One of which, apparently, left his work plan and opted to go to a private plan instead.
Apparently if you are a PBM you can get away with no paying taxes. You know what would happen if I chose to not pay my taxes? Well let's just say I may be sharing a tiny room with a guy named Bubba and a lack of Astroglide at night.
So I have decided, on this glorious spring day, that I will now be a PBM instead of a pharmacist. Judging from experience, I will be able to boss everyone around and not have to do anything that I don't want to do. The money I earn will come at the expense of those around me. This, of course, includes when logic stands in my way.
And of course, I will be free of paying taxes. Because, damnit I won't want to. And since I'm a PBM, if I don't want to do something, I don't have to do it.
Right?
What I do not understand, however, is why they refuse to pay the tax on a drug.
You see in one of the states I have worked in, I keep tabs on my prior employers, many of the PBMs have decided they will not pay for the state tax on the prescriptions we fill. They leave it 'up to the pharmacies' to deal with as one kind PBM rep told an ex-coworker of mine.
The kicker is according to that particular state law, the PBM has to pay the taxes enforced by the state. Yet some how, they're allowed to get away with not paying it.
They are then left with the tax amount and are forced to make the patient pay for it. It is not something that normally I would condone, but seriously what else can you do?
My question is how is this acceptable? Several of the patients who have asked why this has happened have been completely livid with their provider. One of which, apparently, left his work plan and opted to go to a private plan instead.
Apparently if you are a PBM you can get away with no paying taxes. You know what would happen if I chose to not pay my taxes? Well let's just say I may be sharing a tiny room with a guy named Bubba and a lack of Astroglide at night.
So I have decided, on this glorious spring day, that I will now be a PBM instead of a pharmacist. Judging from experience, I will be able to boss everyone around and not have to do anything that I don't want to do. The money I earn will come at the expense of those around me. This, of course, includes when logic stands in my way.
And of course, I will be free of paying taxes. Because, damnit I won't want to. And since I'm a PBM, if I don't want to do something, I don't have to do it.
Right?
Thursday, April 22, 2010
Oxycontin is... What?
"So just to clarify, he has a morphine allergy and I want to make sure you're giving him Oxycodone ER instead of Oxycontin because it has less morphine in it"
**Crickets**
Ok, now that you have probably read that three or four times, I will start by saying, What. The. Fuck.
It took me several explanations for me to explain to her that Oxycontin and Oxycodone contain no morphine in it. She kept reiterating that her computer software was telling her that the morphine allergy was triggering a 'big warning' about an allergic problem to Oxycodone. Thus, she said, Oxycontin must contain morphine.
This was from a CNP out of a major hospital working through a major pain clinic.
Ok ok ok, I'll ask the question the rest of you are already asking in your head.
HOW THE FUCK DO YOU FIGURE THAT MORPHINE = OXYCONTIN???
I mean seriously. I can understand maybe not knowing what Kadian is or something because it is relatively obscure, or at least is so in my area. But how in the hell do you not know what Oxycontin is?
I could ask any crackhead on the street what is in Oxycontin and they would answer correctly. It is one of the most used, and probably most abused, C-II narcotic on the market.
And you don't know what's in it? And you PRESCRIBE for it? And you work in a PAIN CLINIC?
Are you fucking kidding me?
To be fair, she was a rather sweet CNP, but I don't think I can excuse something like that. She wasn't new either, she eluded to the fact she hadn't been in school for quite sometime.
I'm just in shock, utter and complete shock. Anyone else see a problem with this?
**Crickets**
Ok, now that you have probably read that three or four times, I will start by saying, What. The. Fuck.
It took me several explanations for me to explain to her that Oxycontin and Oxycodone contain no morphine in it. She kept reiterating that her computer software was telling her that the morphine allergy was triggering a 'big warning' about an allergic problem to Oxycodone. Thus, she said, Oxycontin must contain morphine.
This was from a CNP out of a major hospital working through a major pain clinic.
Ok ok ok, I'll ask the question the rest of you are already asking in your head.
HOW THE FUCK DO YOU FIGURE THAT MORPHINE = OXYCONTIN???
I mean seriously. I can understand maybe not knowing what Kadian is or something because it is relatively obscure, or at least is so in my area. But how in the hell do you not know what Oxycontin is?
I could ask any crackhead on the street what is in Oxycontin and they would answer correctly. It is one of the most used, and probably most abused, C-II narcotic on the market.
And you don't know what's in it? And you PRESCRIBE for it? And you work in a PAIN CLINIC?
Are you fucking kidding me?
To be fair, she was a rather sweet CNP, but I don't think I can excuse something like that. She wasn't new either, she eluded to the fact she hadn't been in school for quite sometime.
I'm just in shock, utter and complete shock. Anyone else see a problem with this?
Sunday, March 14, 2010
Phones... Where We're Going We Don't Need Phones...
Technology is truly a wondrous invention. The ease at which helps complex tasks be accomplished is truly astounding at times.
Then there are the times when technology is employed for the sake of using technology. In pharmacy, we refer to these as e-Prescriptions.
In any case, I had devised a solution to help get a patient's med paid by her insurance. She was on a funky dose and I was able to appease her insurance by filling it under 3 different strengths. Tedious, yes, but she would have had to pay several hundred dollars extra out of pocket to meet her dosing.
I decided that I would be a good little pharmacy tech and call the office instead of faxing them. My logic was that it wouldn't be impossible to adequately explain everything over the three small lines we have on our faxes.
So I call the office and speak to the 'head nurse'. All of the other nurses and the doc in question are occupied at the moment. I then asked if I could have the doc's voice mail so I could just leave the message verbally. The answer I received made my jaw drop.
"We don't have voice mail at our office anymore."
Excuse me? I inquired as to what options I have to relay this information.
"Well you can fax it or send it over e-Rx."
Let me get this straight, this office has decided to rely, SOLELY, on an electronic messaging system for communication. I did a little more digging and confirmed that they truly no longer have a voice mail system.
Call their office right now and you hear a kind voice asking you to please call back during regular office hours.
Now how in the hell is this possible? I understand the need to want to use the newest and bestest, yes I said bestest, technology, but this is just freakin' ridiculous.
Why even have phones? You could just have the pharmacy and your patients email the office!
Oh shit, maybe I just gave them an idea...
Then there are the times when technology is employed for the sake of using technology. In pharmacy, we refer to these as e-Prescriptions.
In any case, I had devised a solution to help get a patient's med paid by her insurance. She was on a funky dose and I was able to appease her insurance by filling it under 3 different strengths. Tedious, yes, but she would have had to pay several hundred dollars extra out of pocket to meet her dosing.
I decided that I would be a good little pharmacy tech and call the office instead of faxing them. My logic was that it wouldn't be impossible to adequately explain everything over the three small lines we have on our faxes.
So I call the office and speak to the 'head nurse'. All of the other nurses and the doc in question are occupied at the moment. I then asked if I could have the doc's voice mail so I could just leave the message verbally. The answer I received made my jaw drop.
"We don't have voice mail at our office anymore."
Excuse me? I inquired as to what options I have to relay this information.
"Well you can fax it or send it over e-Rx."
Let me get this straight, this office has decided to rely, SOLELY, on an electronic messaging system for communication. I did a little more digging and confirmed that they truly no longer have a voice mail system.
Call their office right now and you hear a kind voice asking you to please call back during regular office hours.
Now how in the hell is this possible? I understand the need to want to use the newest and bestest, yes I said bestest, technology, but this is just freakin' ridiculous.
Why even have phones? You could just have the pharmacy and your patients email the office!
Oh shit, maybe I just gave them an idea...
Monday, February 8, 2010
The Cure-All Medication
As some of the regular readers are aware of I am a racing-fiend. Specifically NASCAR, but I enjoy pretty much all disciplines (I'll get up at 4am to watch a Formula One race for instance). The last few years some of the smaller teams have been signing sponsors from 'drug' companies.
It really started in 2000 when Pfizer jumped on the scene. Ironically the driver's last name was Fuller.
Pfizer stayed in the sport for many years and GSK got in on the act for a while too
And really there wasn't much wrong with it. Then we started getting the 'dietary supplements' entering the sport and it is where the purpose of this post came into play. Namely there has been extensive debate over the emergence of the supplement Extenze entering the sport
Often, since I have a background in pharmaceuticals, I am asked how can something like this be promoted on tv and on a car like this. Most of them are aware that it does not contain an active ingredient, so one would think that the FDA would step in.
And that is a very good point. How is it that products like these can be advertised, and advertised extensively, with little repercussions. We have a hard enough time trying to convince patients that generic brands are equal across the board or that simvastatin will work just as well as Lipitor in treating a patient's cholesterol.
Yet things like this are allowed to be advertised in anyway they please. Usually there is some crack down and fines involved for false advertising (Airborne being the prime example) but by then the damage has already been done.
You would think someone would want to step in and say, "Wait a minute, aren't we undermining legitimate healthcare by allowing these products to be on the market?"
And that is a very damn good point. Then again someone would have to overlook the dollar amounts involved and we all know that isn't terribly likely to change any time soon.
It really started in 2000 when Pfizer jumped on the scene. Ironically the driver's last name was Fuller.
Pfizer stayed in the sport for many years and GSK got in on the act for a while too
And really there wasn't much wrong with it. Then we started getting the 'dietary supplements' entering the sport and it is where the purpose of this post came into play. Namely there has been extensive debate over the emergence of the supplement Extenze entering the sport
Often, since I have a background in pharmaceuticals, I am asked how can something like this be promoted on tv and on a car like this. Most of them are aware that it does not contain an active ingredient, so one would think that the FDA would step in.And that is a very good point. How is it that products like these can be advertised, and advertised extensively, with little repercussions. We have a hard enough time trying to convince patients that generic brands are equal across the board or that simvastatin will work just as well as Lipitor in treating a patient's cholesterol.
Yet things like this are allowed to be advertised in anyway they please. Usually there is some crack down and fines involved for false advertising (Airborne being the prime example) but by then the damage has already been done.
You would think someone would want to step in and say, "Wait a minute, aren't we undermining legitimate healthcare by allowing these products to be on the market?"
And that is a very damn good point. Then again someone would have to overlook the dollar amounts involved and we all know that isn't terribly likely to change any time soon.
Saturday, September 5, 2009
Pfizer Was Fined 132,544,978 Viagra Tablets... And No One Cares
*Note that total was based off the AWP of Viagra 100mg as of the date of this post
I find it kind of funny how the news can be flooded when our president swats a fly, but when the largest pharmaceutical company in the world is fined $2.3 billion for lying to the American people, no one cares.
In what authorities called the largest criminal fine in history, pharmaceutical giant Pfizer Inc. has agreed to pay $1.3 billion, plus $1 billion in civil penalties, for peddling drugs to treat conditions for which the federal government had not approved the medications. Source
Now I knew Pfizer had been spanked by the FDA this year, but I had not realized they were spanked that hard. Yes, they have the funds to pay that kind of cash, but that is a huge wake up call to any of the other dipshit companies who try to pull this.
The settlement focused mainly on Pfizer's promotion of Bextra, an anti-inflammatory drug pulled from the market in 2005 for safety reasons. Source
I was on Bextra for a while after a neck injury when I was 17. It worked beautifully... but it wasn't designed for that use. I remember people coming in who were prescribed Bextra for migraines. That's when I found out what it was actually intended to be used for and it was the first time I heard the phrase 'off-label use'.
Plus you think they would learn after a while
Government attorneys noted this is actually the fourth settlement with Pfizer or one of its subsidiaries since 2002 over illegal marketing, but the fines for those cases totaled only $513 million. Source
So... you haven't learned eh? The biggest and bestest company in its industry in the world can't follow the rules? Sounds familiar...
Pfizer was also accused of fraudulently marketing the anti-psychotic drug Geodon, the antibiotic Zyvox, and the epilepsy treatment Lyrica. Source
The Lyrica one we have become aware of over the past year. Seems as if that is the drug of choice for damn near every condition as of late.
Have a cough? Take 50mg of Lyrica. Trouble growing flowers in your garden this year? Take 75mg of Lyrica.
The kicker is, as far as I can tell, this didn't even make a blip in the news media. Pfizer was effectively dickslapped by the government and the headline on CNN was about a 'John School' for prostitution offenders. Uh huh...
I really feel sorry for Pfizer's stockholders. They have virtually nothing in their drug pipeline for when all their blockbusters go off patent in the next 2-3 years and, I would assume, their planned deal with Wyeth is going to fall through now. I can't imagine Wyeth would allow themselves to be involved with such negative publicity, but then again standards in this country are quite low nowadays.
And that is why the Viagra is so sad in that picture above. Poor poor Viagra.
Monday, June 22, 2009
So You Think You're a Nurse
Anyone who works in pharmacy invariably develops disdain for nurses. I shouldn't say this is for all nurses, because there are some truly great ones out there. I'm referring to the other 90% of nurses out there.
Side note: Ran into a group of nursing students at Dave and Busters a few weeks back. I asked them how they decided to become nursing and all of them said they only got a 20 on the MCAT so they thought nursing would be better for them.... yikes
Anywho I received a call from a nurse who was taking over the home care duties of one of our patients. This patient is very well known to us to the point that when we answer the phone she recognizes our voice and asks us how we're doing. That being said she is on a lot of drugs. I'd say about 20 or so a month.
The nurse I was talking to was probably the most dense nurse I have talked to in a long, long time. By the end of the conversation I was tempted to ask if she went to nursing school in Honduras only to realize that that would be a disgrace to the nursing schools in Honduras.
Some excerpts:
Those are just some of the gems I was asked during this 35 minute phone conversation. My head literally began to throb by the end of it.
Oh and she wanted start dates for all the meds. I don't know how some other pharmacies work, but we do not track initial start dates of drugs. In fact, I can only see about 12 drugs at a time on a patients screen. I went back to mid-2004 to find the start date on her lipitor and hadn't found it yet, but she insisted I give her the exact date.
Seriously, if she's been on something for the past five years, I'm pretty sure the exact start date doesn't really matter.
Needless to say my head hurt afterwards and I was forced to sit down and read some Fark to re-energize my mind.
Honestly, what the hell do they teach in nursing school? Are you that unaware of the simplest medications out there? I mean there wasn't any Tikosyn or Temodar or Procrit involved, these were all very very basic meds.
I rue the day I have to go into a hospital and be treated by some of these numbskulls. Maybe I'll just have to tough it out.
Side note: Ran into a group of nursing students at Dave and Busters a few weeks back. I asked them how they decided to become nursing and all of them said they only got a 20 on the MCAT so they thought nursing would be better for them.... yikes
Anywho I received a call from a nurse who was taking over the home care duties of one of our patients. This patient is very well known to us to the point that when we answer the phone she recognizes our voice and asks us how we're doing. That being said she is on a lot of drugs. I'd say about 20 or so a month.
The nurse I was talking to was probably the most dense nurse I have talked to in a long, long time. By the end of the conversation I was tempted to ask if she went to nursing school in Honduras only to realize that that would be a disgrace to the nursing schools in Honduras.
Some excerpts:
Nurse Ratchet: Ok, so do you have a Di-O-Van-uh 80mg on your list?
Me: Yes, we have a Diovan 80mg which was last filled on 6/18/09
Nurse: Ok... so do you take that like everyday?
Me: (No, it's just whenever you feel like it. Not like its an important drug) Yes, the directions are one tablet daily
Nurse: What about hydrozine 25mg?
Me: Do you mean HydrOXYzine 25mg or HydrALAzine 25mg?
Nurse: Um... I dunno, aren't they the same?
Me: Well Hydroxyzine is an antihistamine while Hydralazine is a vasodilator
Nurse: I see... well let's go with Hydroxyzine
Me: (Let's go with? Are you serious? Do you not understand that these are not even remotely in the same area code)
Me: I also I have a recurring Rx for Darvocet on file
Nurse: Oh ok, what strength
Me: 100/650mg Tablets
Nurse: 100/650mg? There's two?
Me: No, there's 100mg of Propoxyphene and 650mg of Acetaminophen
Nurse: Oh ok. So do you take that orally?
Me: Yes (What else would you do, shove the tablets up your ass? Although your shit may come out bright pink...)
Me: The doctor also updated her Metformin 500mg and changed it to Metformin XR 500mg last month
Nurse: Metformin XR... so that's the same isn't it?
Me: No, it's the extended release version
Nurse: Ok, so the directions are like what, four times a day?
Me: No... just twice daily (With all of the diabetics out there, how do you not know Metformin XR dosing?)
Those are just some of the gems I was asked during this 35 minute phone conversation. My head literally began to throb by the end of it.
Oh and she wanted start dates for all the meds. I don't know how some other pharmacies work, but we do not track initial start dates of drugs. In fact, I can only see about 12 drugs at a time on a patients screen. I went back to mid-2004 to find the start date on her lipitor and hadn't found it yet, but she insisted I give her the exact date.
Seriously, if she's been on something for the past five years, I'm pretty sure the exact start date doesn't really matter.
Needless to say my head hurt afterwards and I was forced to sit down and read some Fark to re-energize my mind.
Honestly, what the hell do they teach in nursing school? Are you that unaware of the simplest medications out there? I mean there wasn't any Tikosyn or Temodar or Procrit involved, these were all very very basic meds.
I rue the day I have to go into a hospital and be treated by some of these numbskulls. Maybe I'll just have to tough it out.
Sunday, June 21, 2009
A Sign of the Downfall of our Society
I was flipping through the channels this afternoon looking for something to watch before the NASCAR race came on. I stumbled upon the name of a show on TLC which caused me to do a double take. The name?
I Didn't Know I Was Pregnant
Ladies and gentleman, let me present to you another sign that our society is going down the proverbial shitter. Even more depressing is that this is an actual series on the channel. Yes, there are enough dumbasses out there for a series to exist.
From the TLC website:
The one I watched involved a 29 year old woman working at a fast food restaurant, shocker, who was already the mother of 3 kids, another shocker. She started bleeding during her shift and thought she was getting her period until she noticed the head of her crotch fruit sticking out of her fun hole.
Now all the people that are interviewing that were there for this 'experience' are smiling and giggling as if it was some cute little story. No this is not cute, this is fucking pathetic.
She 'thought' she had been getting her period for 8 months for one. Seriously, I'm not female, but how do you 'think' you've been getting your period for 8 months. Obviously it would have been irregular enough to notice. Plus, you've already fucking had 3 kids. Wouldn't you think something may be up despite the whole 2 pregnancy tests you took came back negative.
Oh, but it gets better.
She does give birth in the bathroom of her work... while standing above the toilet. Naturally, the baby went head first into the toilet bowl. Then the 911 dispatcher, whom they were on the phone with during the ordeal, had to actually tell them to take the baby out of the bowl.
Here's the thing, the baby is pretty much waving to you as it's coming out. You know by now you're giving birth. Why the hell are you standing above a toilet? Are you that fucking stupid? And I understand shock becomes a factor, but wouldn't you want to immediately remove a newborn from the shitter it just fell in? Jesus Christ....
And again everyone is still smiling and giggling.. oblivious to the fact that there is nothing cute and funny about the situation. You are a dumbass and should have your uterus removed.
I knew TLC had little class judging by the crap they put on that channel now. But honestly, this is a new low.
I Didn't Know I Was Pregnant
Ladies and gentleman, let me present to you another sign that our society is going down the proverbial shitter. Even more depressing is that this is an actual series on the channel. Yes, there are enough dumbasses out there for a series to exist.
From the TLC website:
I Didn’t Know I Was Pregnant is a compelling series that explores the fascinating and utterly surprising phenomenon of women who were completely unaware that they were pregnant...until they went into labor!
From the bathroom floor to a North Woods cabin or from a bridal shower turned baby shower, I Didn’t Know I Was Pregnant will take you into the intense and potentially life-threatening true stories of surprise births. Through reenactments backed up with patient and expert interviews that help shed light on this unique phenomenon, the program will address the many dangers that can be present for both mom and baby. From women who had no pre-natal care and smoked cigarettes, to those who rode bikes in dangerous terrain, they all have one thing in common—sudden labor pains and a baby! One woman even gets the surprise of her life when she unknowingly gives birth to twins!
The one I watched involved a 29 year old woman working at a fast food restaurant, shocker, who was already the mother of 3 kids, another shocker. She started bleeding during her shift and thought she was getting her period until she noticed the head of her crotch fruit sticking out of her fun hole.
Now all the people that are interviewing that were there for this 'experience' are smiling and giggling as if it was some cute little story. No this is not cute, this is fucking pathetic.
She 'thought' she had been getting her period for 8 months for one. Seriously, I'm not female, but how do you 'think' you've been getting your period for 8 months. Obviously it would have been irregular enough to notice. Plus, you've already fucking had 3 kids. Wouldn't you think something may be up despite the whole 2 pregnancy tests you took came back negative.
Oh, but it gets better.
She does give birth in the bathroom of her work... while standing above the toilet. Naturally, the baby went head first into the toilet bowl. Then the 911 dispatcher, whom they were on the phone with during the ordeal, had to actually tell them to take the baby out of the bowl.
Here's the thing, the baby is pretty much waving to you as it's coming out. You know by now you're giving birth. Why the hell are you standing above a toilet? Are you that fucking stupid? And I understand shock becomes a factor, but wouldn't you want to immediately remove a newborn from the shitter it just fell in? Jesus Christ....
And again everyone is still smiling and giggling.. oblivious to the fact that there is nothing cute and funny about the situation. You are a dumbass and should have your uterus removed.
I knew TLC had little class judging by the crap they put on that channel now. But honestly, this is a new low.
Saturday, May 23, 2009
Life as a Suppository
Is there any worse existence than that of a Suppository? Seriously think about it, your three options are rectal, urethral or vaginal. And you know, since your a suppository, that you're jumping into some sort of genital/rectal warfare. Lets break it down a bit:
Rectal Suppository
Perhaps the smelliest location for suppositories, it can be guaranteed that this is a shitty existence. You would only be needed for such purposes as a shit clog (because liquid plumber doesn't work down there) or the always exhilarating inflammation of rectal veins, otherwise known as Hemorrhoids.
Seriously, how exciting is that? You're either going to be entering some place bloody and swollen or once you arrive you will be greeted with a wall of solid shit. The irony of the wall of shit situation is your job is to break down the wall of shit. Truly a splendid job.
Vaginal Suppository
Being inserted into a vagina is the goal of many beings in our world. However as a suppository, you earn this privilege at the most inopportune time. The vagina you could be entering could have an odor similar to bread. You would be blessed with fighting the most lively of all enemies, yeast.
Or perhaps there could be a vaginal infection. Honestly, is there nothing more enjoyable for a vaginal suppository than a vaginal discharge? I think not.
Urethral Suppository
Easily the tightest fitting, and most scary, suppository in existence. One could argue that it takes a man to shove a suppository up his pee hole, yet another could argue that a real man would not need such a device. Plus, when you're in the mood for.... extracurricular activities, wouldn't you think having to shove something up your one-eyed monster ruin the mood?
The next time you purchase or dispense any of these items, I ask you to think of this. The show Dirty Jobs exemplifies the jobs suppositories to. Maybe we should give them their own holiday...
Rectal Suppository
Perhaps the smelliest location for suppositories, it can be guaranteed that this is a shitty existence. You would only be needed for such purposes as a shit clog (because liquid plumber doesn't work down there) or the always exhilarating inflammation of rectal veins, otherwise known as Hemorrhoids.
Seriously, how exciting is that? You're either going to be entering some place bloody and swollen or once you arrive you will be greeted with a wall of solid shit. The irony of the wall of shit situation is your job is to break down the wall of shit. Truly a splendid job.
Vaginal Suppository
Being inserted into a vagina is the goal of many beings in our world. However as a suppository, you earn this privilege at the most inopportune time. The vagina you could be entering could have an odor similar to bread. You would be blessed with fighting the most lively of all enemies, yeast.
Or perhaps there could be a vaginal infection. Honestly, is there nothing more enjoyable for a vaginal suppository than a vaginal discharge? I think not.
Urethral Suppository
Easily the tightest fitting, and most scary, suppository in existence. One could argue that it takes a man to shove a suppository up his pee hole, yet another could argue that a real man would not need such a device. Plus, when you're in the mood for.... extracurricular activities, wouldn't you think having to shove something up your one-eyed monster ruin the mood?
The next time you purchase or dispense any of these items, I ask you to think of this. The show Dirty Jobs exemplifies the jobs suppositories to. Maybe we should give them their own holiday...
Thursday, April 30, 2009
Pandemic 09'!
This swine flu thing is getting just fucking ridiculous. CNN.com has a Swine Flu Tracker. Yes, a tracker. See this piece of douchbaggery here - http://www.cnn.com/2009/HEALTH/04/30/swine.flu.outbreak/index.html#cnnSTCOther2
Is this what our society has come to? Mass hysteria over 300 cases of a flu virus in a population of 6+ billion? Are we that fucking paranoid? Everywhere I go, I see that masks and antiseptic washes are sold out. Never mind the fact we are on the exact opposite side of the country from the border of Mexico, we must be prepared!
The strange thing is, why the hell isn't anyone speaking up about this? You can't tell me there is not a high-up educated individual who doesn't realize what a crock of shit all of this is. I mean if this is nearing pandemic proportions, obviously we have overlooked the great Gonorhea Pandemic of 2005. Or perhaps the Stye Pandemic of 1981.
As a society would should be disgusted with ourselves for letting something like this happen. Personally, I shall be using our store's wiffle ball bat to smack any person upside the head if they start saying they think they have swine flu.
I'll leave you with one last thought, anyone know one of the defintions for swine?
I think that's all I really need to say about that
Is this what our society has come to? Mass hysteria over 300 cases of a flu virus in a population of 6+ billion? Are we that fucking paranoid? Everywhere I go, I see that masks and antiseptic washes are sold out. Never mind the fact we are on the exact opposite side of the country from the border of Mexico, we must be prepared!
The strange thing is, why the hell isn't anyone speaking up about this? You can't tell me there is not a high-up educated individual who doesn't realize what a crock of shit all of this is. I mean if this is nearing pandemic proportions, obviously we have overlooked the great Gonorhea Pandemic of 2005. Or perhaps the Stye Pandemic of 1981.
As a society would should be disgusted with ourselves for letting something like this happen. Personally, I shall be using our store's wiffle ball bat to smack any person upside the head if they start saying they think they have swine flu.
I'll leave you with one last thought, anyone know one of the defintions for swine?
3. a coarse, gross, or brutishly sensual person.
4. a contemptible person.
I think that's all I really need to say about that
Thursday, April 23, 2009
Another idiot medical 'professional'
I have been at work now for.... oh about 63 minutes to be exact. Already I have been dealing with a semi-retard NP.
Faxed off a refill request for a patient that had been on Metformin 750mg BID since the dawn of time. The response I got back?
Metformin 90mg TID
First off, I've never seen a Metformin TID dose. Everything we deal in is BID. Secondly, I've never seen a 90mg dose because they don't fucking make it. Finally the patient had been on 750mg BID dosing for at least seven years. If anything it probably needs to go up.
The sad thing is the NP keeps stating she wants the patient on 90mg TID. Even when I tell her the smallest tablet we can get is 500mg, she still wants 90mg. What. The. Fuck?
Anyone have any idea where the hell she pulled this dose out of?
Edit: I just got a script from another NP for Suprex. Suprex was taken off the market in 2003. Jesus...
Faxed off a refill request for a patient that had been on Metformin 750mg BID since the dawn of time. The response I got back?
Metformin 90mg TID
First off, I've never seen a Metformin TID dose. Everything we deal in is BID. Secondly, I've never seen a 90mg dose because they don't fucking make it. Finally the patient had been on 750mg BID dosing for at least seven years. If anything it probably needs to go up.
The sad thing is the NP keeps stating she wants the patient on 90mg TID. Even when I tell her the smallest tablet we can get is 500mg, she still wants 90mg. What. The. Fuck?
Anyone have any idea where the hell she pulled this dose out of?
Edit: I just got a script from another NP for Suprex. Suprex was taken off the market in 2003. Jesus...
Tuesday, April 21, 2009
Does anyone take Methadone seriously?
Woman came in at the end of a shift to drop off a Methadone Rx for her mother. Her mother has been a patient of ours for decades, so we knew her quite well. She had been in a nursing home the past three months and had only recently been released. What I recieved the Rx I noticed right away that something was wrong. It was written as:
Methadone 10mg, 1tQID
With our Methadone patients I take a special note as to what they usually get and I immediately recognized that this was an increase. Previously she had been on:
Methadone 5mg, 1tTID
So I ask the patient's daughter if there had been a dose increase. She stated that there wasn't, the doc refilled it with the same directions as before. I decided to give the doc a call to see what was up. And do you know what she told me?
She couldn't remember what she was on so she just guessed.
Fucking guessed. On Methadone.
Never mind the fact it would take literally two minutes to check past records, this doc simply decided to take a shot at what it was previously.
How Methadone is legal in this country I have no idea. It is probably the most dangerous prescription medication on the market. The last few years, docs are handing this shit out like candy. We have several patients that are on 600+ tablets a month (our current record holder gets #900 a month) and have been on those doses for what seems like ever. Half the time they show up shit faced to pick it up. Brilliant idea, no?
I just do not understand the lax standards when it comes to Methadone lately. The pharmacist and I both told the patient that she may want to consider a new doc after what occured.
At least we'll prevent one dumbass Methadone prescription.
Methadone 10mg, 1tQID
With our Methadone patients I take a special note as to what they usually get and I immediately recognized that this was an increase. Previously she had been on:
Methadone 5mg, 1tTID
So I ask the patient's daughter if there had been a dose increase. She stated that there wasn't, the doc refilled it with the same directions as before. I decided to give the doc a call to see what was up. And do you know what she told me?
She couldn't remember what she was on so she just guessed.
Fucking guessed. On Methadone.
Never mind the fact it would take literally two minutes to check past records, this doc simply decided to take a shot at what it was previously.
How Methadone is legal in this country I have no idea. It is probably the most dangerous prescription medication on the market. The last few years, docs are handing this shit out like candy. We have several patients that are on 600+ tablets a month (our current record holder gets #900 a month) and have been on those doses for what seems like ever. Half the time they show up shit faced to pick it up. Brilliant idea, no?
I just do not understand the lax standards when it comes to Methadone lately. The pharmacist and I both told the patient that she may want to consider a new doc after what occured.
At least we'll prevent one dumbass Methadone prescription.
Saturday, January 31, 2009
Should We Educate Patients More?
One of the aspects of the pharmacy profession is to educate patients. Educate them on the drugs they take, the interactions they cause and to offer advice when needed. The first two portions are followed religiously, but that can also be attributed to the legal aspects. The last portion, to offer advice when needed, is a highly gray area. It is an area of which I personally would like to explore.
As of late, especially with our current economic troubles, I have been wondering if it is time that we educate our patients on more than just the side effects of their drugs. I have been seeing patient after patient paying ridiculous copays for Nexium and I then ask them if they have ever tried Omeprazole. Most say no, some even say they've never heard of it.
The question then becomes, do I explain the connection between Nexium and Omeprazole? Granted on a chemical level they will not understand it, but it can be easily explained in layman's terms. They could easily save a hundred bucks a month just from that one drug. There's countless other similar situations that this could be applied to.
In my marketing class we have been taught that it is best to educate the company into today's competitive environment. To give them choices, show them all their options and let them make informed decisions. Now I am not suggesting that we let patients decide their medication therapies, but they should be at least be aware of these cost effective options, especially if they are on a fixed-income. So why can't we do that? Why can't we tell the patient paying cash for Lexapro that Citalopram is much less expensive, but will most likely work just as well? That they don't need to pay the $50 copay on Coreg CR when generic Coreg will be covered for a much lower copay.
I think the first hurdle would be to get over the 'MD is god' mentality that a lot of patients have. To me, it appears, that hurdle is eroding under its own weight as it is. Often we are asked second opinions on drugs despite what their doc may tell them.
We all know the Big Pharm is in bed with PBMs. We also all know that it is nearly impossible to bring them down at this moment. Perhaps, though, we could use this to chip away at that formidable facade. Perhaps it would educate the public to the point that maybe a majority will start to speak up for more equality. Then again this is highly idealistic.
Our jobs are to help ensure the health and well being of our patients. If we can help them save money so they can afford their insulin or blood pressure meds, why shouldn't we help them? I know I will be from now on.
As of late, especially with our current economic troubles, I have been wondering if it is time that we educate our patients on more than just the side effects of their drugs. I have been seeing patient after patient paying ridiculous copays for Nexium and I then ask them if they have ever tried Omeprazole. Most say no, some even say they've never heard of it.
The question then becomes, do I explain the connection between Nexium and Omeprazole? Granted on a chemical level they will not understand it, but it can be easily explained in layman's terms. They could easily save a hundred bucks a month just from that one drug. There's countless other similar situations that this could be applied to.
In my marketing class we have been taught that it is best to educate the company into today's competitive environment. To give them choices, show them all their options and let them make informed decisions. Now I am not suggesting that we let patients decide their medication therapies, but they should be at least be aware of these cost effective options, especially if they are on a fixed-income. So why can't we do that? Why can't we tell the patient paying cash for Lexapro that Citalopram is much less expensive, but will most likely work just as well? That they don't need to pay the $50 copay on Coreg CR when generic Coreg will be covered for a much lower copay.
I think the first hurdle would be to get over the 'MD is god' mentality that a lot of patients have. To me, it appears, that hurdle is eroding under its own weight as it is. Often we are asked second opinions on drugs despite what their doc may tell them.
We all know the Big Pharm is in bed with PBMs. We also all know that it is nearly impossible to bring them down at this moment. Perhaps, though, we could use this to chip away at that formidable facade. Perhaps it would educate the public to the point that maybe a majority will start to speak up for more equality. Then again this is highly idealistic.
Our jobs are to help ensure the health and well being of our patients. If we can help them save money so they can afford their insulin or blood pressure meds, why shouldn't we help them? I know I will be from now on.
Sunday, December 28, 2008
While we bailout other businesses...
... why isn't our government taking a look at our healthcare system? I mean we all know it's seriously fucked. We all know that we as a nation could literally save billions of taxpayers dollars a year if some common sense was used.
Case in point, Albuterol CFC is almost officially dead (obit coming later this week) being replaced by it's step-brothers and sisters of the HFA family. The cost has gone from roughly $12 per CFC inhaler (that's prior to the shortage) to about $27 per HFA inhaler.
Now one would assume that medicaid would switch to paying for one of the albuterol HFA inhalers (either ProAir, Ventolin or Proventil). The most expensive of these is about $35 bucks or so. I mean, c'mon, that would be the logical thing to do right? So you know there is no way in hell they would do that. What do they pay for instead? Xopenex HFA.
They will pay for one of the most expensive inhalers out there instead of the cheapest.
The kicker? They have tried telling us that Xopenex and albuterol are the same things. Um...... no the fuck they are not. Advil and Motrin, that's the same thing. Vicodin and Lortab 5, that's the same thing. Xopenex and albuterol are NOT the same fucking thing. One is albuterol the other is levalbuterol. Sure they're in the same class and they do the same thing, but they are in no way the same medication. And then to tell me I can just switch it without the doc's ok? This little fuckin high school dropout running the phones, because ya know she's had oh so much schooling on medications, is trying to convince me I can do this. I finally hung up on the twat once I realized I wasn't going to get anywhere with her. And yes, I just used the word twat, sue me.
You have to wonder how many mindless techs she told this too who went ahead and did just what she suggested. That's downright scary. Luckily I had written her name down and was intending to report her until I heard similar stories from others whom had talked to other medicaid reps. Oh joy.
So while we give out billions do businesses who fucked themselves on their own, it's nice to know that our government is doing the same thing to themselves. Only problem is, who the hell is gonna bail them out?
Case in point, Albuterol CFC is almost officially dead (obit coming later this week) being replaced by it's step-brothers and sisters of the HFA family. The cost has gone from roughly $12 per CFC inhaler (that's prior to the shortage) to about $27 per HFA inhaler.
Now one would assume that medicaid would switch to paying for one of the albuterol HFA inhalers (either ProAir, Ventolin or Proventil). The most expensive of these is about $35 bucks or so. I mean, c'mon, that would be the logical thing to do right? So you know there is no way in hell they would do that. What do they pay for instead? Xopenex HFA.
They will pay for one of the most expensive inhalers out there instead of the cheapest.
The kicker? They have tried telling us that Xopenex and albuterol are the same things. Um...... no the fuck they are not. Advil and Motrin, that's the same thing. Vicodin and Lortab 5, that's the same thing. Xopenex and albuterol are NOT the same fucking thing. One is albuterol the other is levalbuterol. Sure they're in the same class and they do the same thing, but they are in no way the same medication. And then to tell me I can just switch it without the doc's ok? This little fuckin high school dropout running the phones, because ya know she's had oh so much schooling on medications, is trying to convince me I can do this. I finally hung up on the twat once I realized I wasn't going to get anywhere with her. And yes, I just used the word twat, sue me.
You have to wonder how many mindless techs she told this too who went ahead and did just what she suggested. That's downright scary. Luckily I had written her name down and was intending to report her until I heard similar stories from others whom had talked to other medicaid reps. Oh joy.
So while we give out billions do businesses who fucked themselves on their own, it's nice to know that our government is doing the same thing to themselves. Only problem is, who the hell is gonna bail them out?
Monday, December 8, 2008
MRSA shall be defeated!
A few months ago the major public presses were going wild with a rise in MRSA infections. For those who don't remember, MRSA, methicillin-resistant staphylococcus aureus, is an infection which is resistant to most forms of treatment. There are several strains which have been isolated which are resistant to virtually all known forms of treatment. Essentially if are infected with MRSA, which usually happens in communal settings (mainly a hospital), chances are the docs may have a hell of a time getting rid of it.
It is a very serious problem which will only becoming worse over the coming years. Over prescribing of antibiotics and generally lack of understanding of bacteria has effectively left only the strongest of the strains remaining. Most of these are gram negative bacteria, which are even harder to fight due to their double membranes.
In recent years the mechanism behind resistance in bacteria has begun to be understood. There are several factors regarding it, the permeability of the outer membrane, side chains of the antibiotics, polarity, etc, but the big bad boy have been the efflux pumps. Efflux pumps remove antibiotics from the cell once they finally make their way in. Think of them like a bilge pump on a ship. Except that these pumps, in the most resistant strains, move EVERYTHING out. It's like the mother of all shop vacs in a cell. And it's a huge pain in the ass when trying to kill it.
There are several options on how to combat this, none of which are viable at the moment. You can increase the permeability of the bacteria (basically let the antibiotics in faster than they can be pumped out), bind a substrate to the pump (pretty much put a plug in it) and the last option is to alter what the pumps push out. While reading through all these studies, most of which read like a thick ass pound cake, I came across a treatment in the later option that was rather intriguing. They have found that Verapmil and Reserpine inhibit the pumps and allow antibiotic concentrations to rise.
Think about that now. How long have those drugs existed? How many people the world over have been on such a regiment? That's pretty damn cool if you ask me, that something which has been used for years and years has yet another viable function.
They will never be used in humans as a treatment as the levels needed to inhibit the pumps are highly neurotoxic. There is also issues with purification of the needed amounts of the compounds. What they are doing instead is using those two drugs as a start point to construct new, less toxic variations to inhibit pump function. It is one of the most promising fields of micro and molecular biology at the moment.
Stumbled across this while writing a paper on antibiotic resistance in bacteria for my microbiology class. Was a vastly interesting tidbit that I thought all the other pharmacy nerds would enjoy.
Now back to my macroeconomics paper on universal health care :D
It is a very serious problem which will only becoming worse over the coming years. Over prescribing of antibiotics and generally lack of understanding of bacteria has effectively left only the strongest of the strains remaining. Most of these are gram negative bacteria, which are even harder to fight due to their double membranes.
In recent years the mechanism behind resistance in bacteria has begun to be understood. There are several factors regarding it, the permeability of the outer membrane, side chains of the antibiotics, polarity, etc, but the big bad boy have been the efflux pumps. Efflux pumps remove antibiotics from the cell once they finally make their way in. Think of them like a bilge pump on a ship. Except that these pumps, in the most resistant strains, move EVERYTHING out. It's like the mother of all shop vacs in a cell. And it's a huge pain in the ass when trying to kill it.
There are several options on how to combat this, none of which are viable at the moment. You can increase the permeability of the bacteria (basically let the antibiotics in faster than they can be pumped out), bind a substrate to the pump (pretty much put a plug in it) and the last option is to alter what the pumps push out. While reading through all these studies, most of which read like a thick ass pound cake, I came across a treatment in the later option that was rather intriguing. They have found that Verapmil and Reserpine inhibit the pumps and allow antibiotic concentrations to rise.
Think about that now. How long have those drugs existed? How many people the world over have been on such a regiment? That's pretty damn cool if you ask me, that something which has been used for years and years has yet another viable function.
They will never be used in humans as a treatment as the levels needed to inhibit the pumps are highly neurotoxic. There is also issues with purification of the needed amounts of the compounds. What they are doing instead is using those two drugs as a start point to construct new, less toxic variations to inhibit pump function. It is one of the most promising fields of micro and molecular biology at the moment.
Stumbled across this while writing a paper on antibiotic resistance in bacteria for my microbiology class. Was a vastly interesting tidbit that I thought all the other pharmacy nerds would enjoy.
Now back to my macroeconomics paper on universal health care :D
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