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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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Tele-me-more

by Elixir on May 5th, 2010 - Anecdotes, From the frontline, Patient Care

At the outset of writing this I can’t help but think of a recent Beyoncé/Gaga offering  – who doesn’t love that scene in Lady-Gaga-and-Beyonce-Telephone-gone-too-farTelephone when they escape in the PussyWagon? No one, that’s who. Also a rather hard core alternative to the solo-Beyoncé effort of Videophone which to be honest is rather Lara Croft, if you ask me. But I digress.

I’ve been reading quite a lot lately on telemedicine, the art, if you will, of providing medical advice and services over the telephone/internet. In essence, this allows those who normally have limited or no access to health professionals/care the resource of communicating with medical professionals via telephone and internet.

A recent article in Pharmacy Choice teases at the notion of an expanding industry in the US, saying that  [the company] American Educational Telecommunications allows rural patients and health care providers to work with medical professionals at regional or urban medical centers. AET’s technologies also facilitate distance learning to train medical professionals in other parts of the world; the company’s technologies help ensure that rural populations have access to the same quality of medical care as those admitted to hospitals.

Even more…I think the word I’m looking for is…intriguing…is that I have now heard that some US hospitals are hiring pharmacists who work off-site, some working as far away as Europe and Asia. They receive the electronic patient records and doctors’ orders and authorise prescriptions which are delivered on-site. From what I hear, the pharmacists are extensively contacted for advice  and communication ensues as it would if the pharmacist were there, save for of course the pharmacist to patient interaction.

I think I have convinced myself that this is a BRILLIANT idea, one that sparks enthusiasm for underserviced areas the world over.  The pharmacists have the continued opportunity to practice the art of medicines management, what they do best while at the same time the convenience of staying chez lui. Win-win.

The biggest argument I see arising is, as mentioned, the lack of pharmacist-patient interaction. But, let me be the devil’s advocate, just for a teeny moment. Does it really matter? As much as we have fought to be recognised as a healthcare provider and not just a medicines dispenser, doesn’t our TRUE value still lie in what we can provide with regards to medicines information and how that may best be of use to patient recovery?

Of course it’s better to have a pharmacist onsite, but if the choice is between telemedicine providing the information for someone else to use and no pharmacy-services at all, dial me up.

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It’s just a bill, sitting there on Capitol Hill

by Elixir on March 21st, 2010 - From the frontline, Patient Care

Our friends in the USA are facing some tough decisions this weekend regarding healthcare and how/if the millions of schoolhouse rock bill2uninsured in the country will finally be offered an olive branch of hope from the Federal Government’s new healthcare bill. Although,  a sharp bite of reality is that healthcare reform of such a remedy will not come without a spike in taxes, for all…a consequence usually met with less enthusiasm by the American public than the lack of healthcare itself.

I’d like to commend the American Pharmacists Association (APhA) for their amazing coverage of the proceedings AND for their wholehearted committment to getting pharmacists in the ring as key players in improving healthcare via their knowledge of medicines and ability to connect to patients outside of the doctor-patient route. Their Message to Congress includes five key strategies that aim to prove that costs can be lowered AND patients can have better access to medicines and medicines information when pharmacists are more extensively utilised, accessed and supported (including graduating more pharmacists to fill poorly serviced rural communities).

What I like most about APhA’s campaign is their goal to involve their Members – individual pharmacists – in the fight for healthcare reform and improved care via the efficient and effective use of our profession. Not only were Members invited to film videos about what they would tell President Obama about the pharmacists role in healthcare reform (watch videos here), those who attended the recent APhA National Meeting in Washington DC were invited to go on tours to Capital Hill  to REALLY get their voice heard! Although many things about the States frighten me like a scared turtle into a shell (flagrant gun use and monster  “feed a family of four on one burrito” -sized meal portions highly ranking), I HIGHLY commend this sense of empowerment from APhA to it’s Members – GO PHARMACISTS!

I’m also very curious to see the result of a healthcare bill (let us all thank School House Rocks for making the journey from bill to law a  rockin’ good time),  but I’m more curious to know – what would YOU tell Obama?

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Banned Ads

by Elixir on March 7th, 2010 - From the frontline, Industry News, Patient Care

googleOver the past few years there has been considerable debate about direct-to-consumer advertising – banned in most countries, the US and New Zealand are the only two countries where patients/consumers are confronted with direct publicity regarding a certain drug/disease condition/cure/treatmet etc (such commercials have also become easy prey to satirical comedy shows like Saturday Night Live who love the fact that the commercials spend just as long listing the side effects as the benefits…legalities, I’m sure). The British Medical Journal has gone as far as to conduct research and publish articles on its influence on patients.

What has been less discussed, until now, is the issue of direct-to-consumer pharmacy advertising.  A non-issue for the most part – people go to their regular pharmacy OR the nearest pharmacy, that’s just the way it is. But, with the advent of online pharmacies and the inherent…differences (ie lack of personal interaction between the patient and pharmacist and legal credibility) they pose, things are cracking down.

HealthBusinessBlog was one of many to report Google’s crackdown on online pharmacy advertising in the US and Canada, stating that they will only post advertisiments for those online pharmacies registered under the Canadian International Pharmacy Association and the US National Association Boards of Pharmacy. Google AdWords are brief in their explanation but make it clear that the days free for all advertising of any and all online drug dealers, if I may use the words, are over.

What do I have to say about this? THANK YOU GOOGLE.  I worked for an  “online”  pharmacy during it’s economic and unrestricted renaissance and heyday about 10 years ago, and although my then employer was legit and did provide patients with less expensive medicines, there were undeniable, inherent problems.

The biggest of which came in the form of copycat pharmacies, which employed few if any pharmacists and in some cases contracted sub-par and (illegally) narcotic/restricted medicines, leading to sub-par treatments, abuse and in some cases, deaths.  In fact, our legally inclined friends in the US have even started a website on how to sue online pharmacies for malpractice, which somehow seems more in the spirit of capitalism than patient safety…but I digress.

There are more issues surrounding this issue than there is space for here, but  the reason why these online pharmacies still flourish I believe  is the direct result of two very key notions: 1. people value cheap medicines above any risk involved in online ordering and 2. we still have NOT made ourselves an invaluable, physical, moral and societal  connection between patients and medicines.

What’s it going to take?

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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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Give peas a chance

by Elixir on February 21st, 2010 - Anecdotes, Patient Care

give-peas-a-chanceOn various fronts, much of the past week has been spent discussing healthy eating and lifestyle choices, which, in the nerdy circuit, can quickly turn into a discussion of the pharmacist’s role in public health. In all honesty, it mostly turns into a ping-pong match of: Friend #1 wanting to do crazy diet, me explaining why that is a tremendously horrible idea, Friend #1 doesn’t believe me, fellow Pharmacist Friend agrees with me, Friend #1 pretends to reconsider but is fooling no one. *sigh*.

But, isn’t Friend #1 a good example of the general public? Let’s be honest, everyone wants an easy way out to healthy living, or to pay some Ex-Navy Seals trainer to keep us in place. As a wise person once said, we’d all look like runway models if someone were smacking the Doritos out of our hands every day.

This prompts an interesting discussion though – what IS the role of the pharmacist in public health? What COULD it be?

In a previous post I waxed poetically on the downfall of healthy eating as a direct cause of the upswing in in several pharmaceutical markets. What I’m talking about now comes way before that – are we doing enough for preventative health BEFORE the problem arises? I will take it for granted that all of us have spoken/are speaking to those clearly in need of health interventions, but are we talking to the seemingly healthy people? Or their children?

The impact of us wearing the Public Health hat is still being researched and debated; such studies take years and involve analysing the (hoped)  decline in chronic disease as directly related to pharmacist interventions.  The American Public Health Association the Journal of Epedemiology and Public Health and countless others have been rallying up articles for years in support of such initiatives which look to steering curricula development and payment for services regulation – all, still in various stages of evolution.

For me, a see the importance of our role at a much more personal level. When we see the patients, they are not in a study, they are just there, in the pharmacy, ready to listen to us, even if we are telling them to cut down on the beer and nachos.  Our white coats and attitude can influence our patients’ courses of action far more than we think sometimes; let’s not waste the opportunity.

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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 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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