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OTC yeah you know me

by Elixir on May 9th, 2010 - Medicines, Patient Care

prilosec_feature3In an attempt to cease and desist several (hopefully) temporary ailments, have to do some battles with some OTC meds this weekend. In my current place of residence the choice is slim and not entirely inspiring…nor effective.  Not to mention that their availability is placed almost solely in “parapharmacies” that resemble anything but a pharmacy, especially in their choice of meds.

On the contrary, I remember taking a spin through a pharmacy in a recent visit to the States. If any country has perfected the art of the Over The Counter Medicine, it is the United States. I was actually quite shocked to see Prilosec OTC front and centre (I was, perhaps naively, even more shocked to see that their website offered a free sample…thank you, Proctor and Gamble).

Don’t get me wrong, it’s not that I don’t fully appreciate the ease of availability of this and these types of medicines – I am pining for such this weekend, actually. But something like Prilosec (omeprazole for the generically tied) screams for pharmacists intervention for reasons which will all know yet I feel compelled to relist here – chronic treatment of symptoms for a potentially harmful underlying cause could lead to even more damage and serious conditions.

What scared me even more however was that I was browsing through the US FDA website for their guidelines on Regulation of Nonprescription Products to find these points explicitly listed:

OTC drugs generally have these characteristics:

  • their benefits outweigh their risks
  • the potential for misuse and abuse is low
  • consumer can use them for self-diagnosed conditions
  • they can be adequately labeled
  • health practitioners are not needed for the safe and effective use of the products

Now from what I hear about the FDA combined of what I hear about the American populace’s tendency to lawsuits I am almost certain that a very large team of very smart experts came up with these guidelines. But I’m not sure I agree, to be honest. Sure, anyone can read the box…but do we really want to encourage more self-diagnosis? And, are we really comfortable by saying a medicine like omeprazole can truly be used safely and effectively without interaction with a healthcare professional (namely, pharmacists).

I’m not. I admit I would be more likely to agree if more were a “behind the counter” (BTC?) medicine that needed to be requested. The slight increase in bother would go great lengths in prevention and in connecting patients to pharmacists – a step that seems to becoming increasingly eliminated.

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Hack THIS!

by Elixir on February 28th, 2010 - From the frontline, Medicines, Patient Care

I just read a blog post at LifeHacker.com that at first had me SEETHING and then had me empathizing and now has me split-pills-157on the angy side of irritated.

From what i can get from this blog is that Blogger LifeHacker is offering folks ways to save money in every day life. Wonderful concept,  one that we can all get behind..when you’re dealing with things like recycling wine bottles for garden aisles, as in the latest post. But what’s got me riled up is that in a recent “suggestion”  LH is recommending people to split their PILLS IN HALF to save money via dodging co-payments and refill charges – common surcharges in some countries that can exponenially raise the price of medicines.

DISCLAIMER:  Granted, LH does tell the reading masses that not all pills can be split and to please ask your doctor or pharmacist which ones can be (some [loser] commentors only keep mentioning that your doctor is the best person to ask. DING DING DING – WRONG! You know who’s yo’ Daddy…).

What gets me is the headline – Use a Pill Splitter to Keep Pharmacy Costs Down. This is enough  to send many (especially those who are struggling with medication costs in uninsured and poorly healthserviced countries) running to the bottles without reading any further. DANGER WILL ROBINSON (**arms flailing, arms flailing**).

As community pharmacists we have all seen people do this; many of us have split the pills for people ourselves, and indeed, this is ONE way to offer savings to those who need it…IF it is done properly (and even then, I’m skeptical…medicines are made in dosages for a reason).

But if  not done properly, it could lead to disaster, as we all know – under or non-effective pills are not only a waste of money, but a threat  to well-being. I find this shockingly scary that this (assumed) non-health professional  is throwing out potentially dangerous suggestions like home-made cookies.

The comments are interesting and range from doctors, industry people, pharmacists and patients. Worth a read.

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The Pill Made Me Hate You

by Elixir on February 26th, 2010 - From the frontline, Medicines, Patient Care

badadsovulen21OK, we all know, boys and girls alike, that the female of the species tends to have a much larger variation in mood than say our male counterparts. Why, just today I went from slight giddiness at finding a completely new transport card in a bag I hadn’t used in awhile to the rage-y side of annoyance at a work situation…and this is a normal day. (For an extremely funny perspective on a not-so-normal day, I recommend reading this Consumer Letter, chosen as the best of 2007. The men may be frightened…).

But, there is now evidence that often, we may just be at the mercy of our pharmaceuticals -  a new study that was featured in Scientific American edges on the idea that the birth control pill, or, rather, stopping it, can be a culprit in the million+ divorces that the United States sees annually.

The article explains that the hormonal variation that occurs when starting/stopping the BCP (as those in the biz like to call it) could be blamed for altering women’s taste in men, one minute creating wanton sex goddesses on the prowl and the next baby mama types looking for the Manly All Protector/Provider.

And those who have enjoyed nuzzling up to a monsieur wearing Hot Guy Cologne (or shopped at Abercrombie in the last, ever…) will agree with the article when it says “it’s all about scent”…and of course being scientific in America, the sciencey part of scent, major histocompatibility complex (MCH) genes. The ladies want the guys with different ones to complement their own and produce more viable offspring (this combination also seems to create Samantha tendencies, to give reference to everyone’s favourite Sex and the City goddess); the Pill, however, could shift focus to los guapos with similar MCH’s (and, shall we say, more Charlotte leanings. And PS I want that outfit in the last link).

All this is fine and good, but what does this mean for our women patients who are on/off/on the pill, which is quite frequently the case? I think it’s our job to make them aware of all the possible consequences of taking medicine, but I fear this could lead to a very effective (and revolutionary – let us not forget the sexual revolution and “right to choose” movements stemming from this little pill. The Retrospace blog has some groovy comments on that. ) medicine being accused of the basis for  marital discourse…

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The Genius of Germs

by Elixir on February 14th, 2010 - From the frontline, Medicines

bacteriaPrior to becoming a pharmacist I spent four  information-filled  years honing my skills as a micro and molecular biologist. I gave up on that quest after realising that the bait of success only came with years toiling in the lab and filling out grant proposals through a Masters then PhD. Although I was still stuck in my “anti-social-unbelievably-nerdy-nonstop-study” years of youth, even I could recognise this was not for me. But, I often think back to all that I learnt during that time and think WOW, this stuff is freakin’ cool!!  And even more fascinating for me is that after millions of years of evolution that have humans thinking we are the Top Dog, so to speak, the bugs, in so many cases, are still winning.

Wired.com has become such a great source of cool articles lately and one of the last  I read was on antibiotics and breeding of  crazy-assed super bugs destined to destroy life as we know it, á la Alien but in microscopic form. Ok as usual I’m exaggerating but the more significant  – and scary – point of the article is that resistance to antibiotics is inevitable through mechanisms that scientists are still figuring out and that are blowing away previous theories. No matter how far ahead we think we are, these invisible creatures are creating new mechanisms of survival that result in unmanageable infections…and, human death.

Even if we eliminate misuse and abuse of antibiotics (the impossible dream) resistance will still occur. This is scary when considering, as Wired states, that in 1999 Cipro eliminated 95% of  E.coli infections; by 2006 it was 60%. What does this mean? A lot of  diarrhea, that’s what it means.

But what is nagging at me the most about the article is that of the 35 million POUNDS of antibiotics consumed by our friends in the United States PER YEAR (like, WTF!!!!), 80%  is used for farming and agriculture purposes, resulting in the ultimate breeding ground for super bugs – namely multi-drug resistant Staph aureus, which is said to kill more than 20 000 people each year. That is more than AIDS, if you check the stats. And it’s a hard sell to get everyone on an organic movement considering the profit base for both the food AND drug industry.

I can honestly say I have no idea what this will bring…four years just wasn’t enough to know…

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You want me to do WHAT?

by Elixir on February 12th, 2010 - Anecdotes, Medicines, Patient Care

With blatant disregard to my self-imposed dedication to  prepare and eat food INSIDE the home, after work today I shockedstopped by to get some dinner at my fave noodle bar. As Noodle Guy was counting out change to the person in front of me (I myself  live in my own cashless society and seldom carry more than a selection of plastic) I was reminded that during my stint at an independent pharmacy, this was one of my jobs – day-end money inventory. I hated it…as it meant that my Friday night shifts only teased me with their possible end at 8pm…I still had another 45 minutes of cash counting ahead of me.

What got me riled up even MORE was that these same independent pharmacy owners also wanted me to count the LOTTERY TICKETS, which they sold at the front counter.  So there I am, watching the daylight hours tick away on a Friday evening while the technician and I stack up the Scratch ‘n Wins. The scathing irony of taking 8 years of university to count lotto tickets in the back of a run-down pharmacy was reason enough to question my career path.

After being pushed to the limit at Independents ‘R Us I moved on to a bigger chain store, where I continued to be asked to do things I now keep on reserve for mortal enemies and puppy killers, albeit of a much more clinical nature  I have been asked to identify head lice (on a lady who completely rejected the notion while she scratched her head raw); comment on ear infections (for a poor kid who’s ears were bleeding and leaking…infectious stuff…like get this kid some Amoxil); recommend an enema for a very…non-traditional use (this could take up a blog post of its own on the 18+ POQD site) and observe a live viewing of diaper rash…for an 85 YEAR OLD MAN… who pretty much took off the diaper in the pharmacy.

Listen, kids…I seriously did not sign up for this. I originally went in to pharmacy so I could use the organic chem to go into perfume manufacturing. L’Air de la Réalité…welcome to pharmacy practice.

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Electronic Technotronic

by Elixir on February 1st, 2010 - Medicines, Patient Care

In a complete switch from normal office life I had a little tangle with the healthcare system myself today, but as a recipient rather than provider. I laughed, I cried, it was better than Cats.

0763758493While I was waiting politely to be either diagnosed with three months to live or to be released into my own paranoia I thought I’d get my new doc on the up and up and order the round of scripts I normally need. With spring  just around the corner (THAT’S RIGHT…with SPRING just around the CORNER…) I will soon be plagued with the unyielding onslaught of seasonal allergies that have me stuffy/drippy/sneezy/wheezy (enter the new Dwarfs), so time to stock up on the Aerius.

Did she pick up pen and pad and scribble illegibly about, hither-tither? HARDLY. With a click click here and a click click there, my new (and already well liked) Doc had moused her way through the online records, made some notes, surely clicked control-something and VOILA! My scripts were instantly mailed to my pharmacy of choice, ready for pick-up my the time I got there.

EFFICIENT! EFFECTIVE! E-RIFFIC!

I honestly fail to find a downside to these electronic prescription services, aside from the nostalgic tie to the old-time apothecary scribblings of yore. They are easy, as mentioned efficient, remove the need for a PhD in decoding handwriting and provide an instant record on both sides – physician and pharmacy. They seem to be getting more and more popular as well, as even the health system in the UK supports the initiative.

What do you think? An almost perfect solution, or false security?

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The pharmacy, and beyond!

by Elixir on January 26th, 2010 - Anecdotes, Medicines

Since the last posting on our friend Freddy Pharkas, Frontier Pharmacist, I’ve been thinking suitcasea lot about where and when my next adventure will be. Ok, admittedly not JUST because of Freddy but let’s say I was moved by his spirit to discover unkown people and territories…and give them medicines.

Randomly handing out meds is not something I do on a regular basis when I travel but lately I’ve noticed that I dole out advice quicker than a visiting mother-in-law. And most of this is unsolicited, ergo…I’m thinking likely unwelcome (or at the very least ignored).  Intentions are only the best, of course, but looking back I doubt my non-sciencey colleagues really care to hear the exact mechanism of sodium and potassium exchange that drives the electrical current of the heart. Frankly that was hardly my favourite subject back in the day either, and yet, i just couldn’t help myself attempt to educate the masses.

What I have come to appreciate more and more, however, is the transportability  of my knowledge base as a pharmacist. Unlike, say, a concert cellist (who doesn’t love a little  Yo Yo Ma at dinner?), I don’t need to book an extra seat on the plane to take my expertise with me.

And this has come in quite handy as I have traveled here there and everywhere, not to mention in between. On a recent flight and long flight back home the flight attendants actually called for a pharmacist, as a passenger had collapsed and the other medical staff on board needed to know if it could have been too much/lack of meds. Nothing stood out, but I thought, wow, I’m sort of helping (and I didn’t have to get that close to the puking passenger…).

And just the other day I was mentioning to a colleague, a mom of a nut-allergic child, that she should keep some Benedryl (diphendydramine) on hand along with the Epi pen. They all tend to tune out the “WHY” but seem to trust me nonethless, and we are likely both thankful I have more to offer than a riveting monologue on the Action Potential of the heart.

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The Red or the Blue pill

by Richards on January 20th, 2010 - Medicines, Patient Care

Matrix

It always keeps intriguing me how patients choose their medicines. Of course the Pharmacist and the Physicians are steering the process for the most part. But if the patient is standing in front of the counter and reads aloud what the doctor prescribed (or rather just hands over the paper which is not readable most times anyway), what happens then? In most cases the Pharmacist will just pick the right box and the patient pays and leaves the store. But what happens if the exact brand is not available in the pharmacy? Or the health insurance makes the pharmacist prescribe another brand? In some cases I witnessed that patients get confused, they really want to have exactly what the prescription says or exactly what they had last time. Otherwise they have the feeling it will not cure them. Although generics and brands do have exactly the same effect, they do not look the same.

They have a different brand name. They do not have the same colour box nor the same colour pill. They have different flavours maybe and sometimes may not even look the same by law. But how will this give the patient trust, how will he or she believe that everything is going to be all right. I think you can really compare it to cars or clothing for example. If someone hears Pfizer they immediately know that it’s a very well known brand, they know the colours and letter type, they know the logo. If the pharmacist offers them a generic brand for example, will they think it will have the same effect? It looks different but how can it ‘taste’ the same? How can it have the same effect?

If I buy a red t-shirt at the Hugo Boss store it has this tiny Hugo Boss logo on it. If I buy a red shirt at the local grocery store it has no logo but other than that the shirts look exaclty the same. Why do I still want to buy Hugo Boss rather than the grocery store? Of course with clothes it is all about the image and the status. Same with cars, who would drive a Toyota when you could also drive a BMW? I think with medicine it’s not all that different. People would want to buy the best, it’s their health! They want to buy something that is familiar, a known brand that has a more trustworthy image. A logo and brand name they know already. A brand that has a strong positive image so they think it has a certain high quality. Because without this quality it will not make them better.

What is the power of pharmacist here, can they make patients overcome the branding and convince patients that red equals blue? Or do they capitalise on it for their own benefit?

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Resolutions

by Elixir on January 9th, 2010 - Anecdotes, Medicines

The buzz on the street the past week has udoubtedly been about resolutions, those inevitable New Year rules of embetterment, self- inflicted upon ourselves for the purpose of achieving some sort of moral, spiritual and/or physical improvement.  I have a few myself, although having cut out most  solid foods in earlier rounds mine  are leaning towards the deathly boring variety, a la “pay off Visa card”.krusty

I predict that losing weight will once again top the developed world’s list of goals for this year, along with quitting smoking, both daunting and often unpleasant tasks smack full of self-denial and misery. When thinking back to my days in the pharmacy I tend  refer to these as the “eternal plagues”,   as patients struggled time and again to shed the pounds or kick the habit only to return to base camp, so to speak. Also conjures up images of  The Simpson’s episode when Krusty the Clown was covered in nicotine patches. (Is there any thing that can’t somehow be made  more relevant by The Simpsons? I think not.)

Why are these two reslutions so difficult to achieve? Well, I could wax poetically on the positive-feedback loop of nicotine and exceptionally delicious and usually high calorie foods on the pleasure centres of the brain, ie the chemical process of addiction,  but that usually doesn’t help much. Best to just accept the fact and move on. And “cheating” with meds such as fat-blocking Xenical (anal leakage, anyone?)  or Nicorette gum almost always fails to truly dull the pain (even the Nicorette website gives way to this admission with their slogan “Quitting Smoking Sucks”. Indeed.)

As I told a friend recently, the only way this works is to find your motivation. Why will it be different this time? Who or what is your muse? What is making this important to you? Without these questions answered with reasons strong enough to smack the Doritos out of your hand, I fear we will see you back  in the pharmacy next year.

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Placebo vs Big Pharma

by Elixir on January 6th, 2010 - From the frontline, Industry News, Medicines

I just read a fascinating article on Wired.com called Placebos Are Getting More Effective. Drugmakers Are Desperate to Know Why.  The basic point was that the placebo effect, ie the phenomenon of patients recovering from illness when given “fake” pills rather than real ones (or, as studies show, even anticipating taking medicines), has grown so significantly over the past 20 years that Big Pharma, in all their glory, is shaking in their well-heeled boots.

The article cites numerous examples of  new medicines are being stopped in Phase 1 and Phase 2 Clinical trials because they have not shown a statistically significant improvement in curing disease over the placebo medicines; a method of measuring effectiveness known as the randomised, controlled double-blind clinical trial borne in the 1950’s by anesthetist Henry Beplacebo.echer, a WWII doctor turned researcher who witnessed a wounded soldier find relief from a syringe of saline solution when told it was morphine.

The placebo effect is nothing new, we have all heard about it and I would say most believe in it. What IS new is that the worlds of drug research, development, trials and marketing are now considering the placebo effect a real threat to the release of new medicines; the US FDA will not release a medicine for use if it has not beaten placebo in two trials.

And, why should they? Why should patients take medicines when they can heal themselves?  Ah if it were only so simple. What I find most fascinating in the article, as a scientist, pharmacist and patient alike, is the conditions under which the placebo effect is most, well, effective. As Wired extensively goes on to explain, the  rise of  unaware self-healing has paralleled the rise in medicines  manipulating complex neurological functions – those that regulate mood, happiness, well-being and in reverse those whose malfunction cause depression, anxiety and other detrimental psychiatric disorders. The author goes so far as to  suggest that blockbusters like Prozac, which has achieved record breaking, billion dollar sales  for Eli Lilly in ‘curing’  depression, may not truly fair significantly better than placebo.

But it was not just the fake meds themselves, it was the act of taking the medicine, the demeanor of the health care providers around them, and the inherent HOPE of getting better that was often as much to do with the healing as the little sugar pills themselves.

What does this say to us? Well, I still firmly believe that medicines should be taken when medicines are needed – as Wired says, no one will dispute the fact that anthracycline shrinks cancerous tumours. But what it speaks to is our incredible ability as humans to make ourselves better, given the right circumstances…and sometimes just the right coloured capsule.

Read the full article at Wired.com here

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