Wednesday, January 27, 2010

I Bitchslap The California Pharmacist's Association.

Regular readers of my little blog garden already know about last year's California State Assembly Committee hearing on retail pharmacist's working conditions, and they've heard me take the California Pharmacist's Association to task for declining an invitation to attend. I did it again recently in a column for the trade magazine Drug Topics that may be working its way to your mailbox as I type. That prompted this lovely note from Lynn Rolston, CEO of the California Pharmacist's Association:

I wish you would check facts before you print opinions such as this one. CPhA would never decline to speak out on behalf of pharmacists. We were not asked to attend. We did not decline. This is a rumor that I would love to stop as it is unfair to CPhA staff and members who work so hard to advance the profession!

Well, tonight I make Lynn's wish come true. Here's a little fact-checking I did before I wrote a thing about that hearing:

Were any professional organizations, such as the American or California Pharmacists Association involved? Was their input solicited?

We invited the California Pharmacists Association to attend and testify, but they declined our invitation.

That was from an e-mail interview I did with Ben Ebbink, who is the Chief Consultant to the Assembly Committee on Labor and Employment. Ben had no reason to lie to me.

But Lynn Rolston now says he's a liar.

Well you know what? Let's go with the small chance that he is. That Ben Ebbink pulled that out of his rear end for some reason and no invitation was issued to the California Pharmacist's Association to a hearing that discussed California Pharmacist's working conditions.

Don't you think the California Pharmacist's Association would be a little pissed off about that?

I mean, The California Retailer's Association was there.

So was The United Food and Commercial Workers Union.

Academics, advocates for senior citizens, students, even someone from The Coalition for Humane Immigrant Rights of Los Angeles all showed up.

Yet no one from the California Pharmacists Association. Huh. So basically what Lynn Rolston is saying, to paraphrase a bit, is.

WE DID NOT DECLINE AN INVITATION TO THIS HEARING!! WE WERE JUST CONSIDERED TOO UNIMPORTANT TO WARRANT ONE AND WERE TOO INEFFECTIVE TO CHANGE ANYONE'S MIND ABOUT IT!!!!! SO THERE!!!

Well that's much better Lynn, thanks for setting the record straight. And way to stick up for the profession. Regardless of which one of you is lying, way to totally stick up for the profession.

Why on earth anyone is sending a dues payment to that organization is beyond me.

Sunday, January 24, 2010

Wow. It's Like I'm A Lit Match And APhA Is A Gallon Of Gasoline.

It would seem I've touched a bit of a nerve with that printed APhA piece of mine. The e-mail has been pouring in, with exactly one message to date defending the organization too ineffective to get all the letters in its name capitalized. The pharmacy blogosphere is a-buzzin,' and the printed issue of the magazine isn't even out yet.

Note to APhA. Maybe next time you'll return my calls.

In the interest of striking while the iron is hot, I thought now might be a good time to dust off a golden oldie.  This post originally aired last January. Enjoy.

A Letter To John A. Gans, APhA Executive Vice President and CEO


I saw your commentary in the December, 2008 issue of Pharmacy Today this afternoon. What wonderful words:


If you’ve started your MTM offerings but are still in the fledgling stage, is now the time to ramp up, do some marketing of what you have, or add services you’ve been thinking about? I hope so. Every time we look at the impact of pharmacist services on a chronic condition, the results show dramatic improvements in clinical, economic, and humanistic outcomes. Whether it’s diabetes or depression, your counseling, education, and coaching of patients can help them live longer, better lives. What better gift can you offer your patients during this holiday season?

I couldn't agree more. How exciting it will be once I have an opportunity to apply my services to the chronic conditions that afflict so many of my people. Yes, what better gift could I give them? I do have one question for you though.

What planet do you live on? It may interest you to know that your words, written in who knows what corner of the universe, reached me here on Earth, the pretty little blue and white planet third farthest from our sun.

Actually it's probably no use to describe to you exactly where my planet is, as you are obviously somewhere very far away and very different. You see Mr. Gans, on Earth, most pharmacists work in places called "drugstores" or "retail pharmacies," and to the businesspeople who run the corporations that operate these "pharmacies" the concept of this "MTM" of which you speak is as alien as the neon fluorescent glow I imagine your beings as having as a result of the radically different respiratory processes that keep you alive in an environment so different than mine.

Do you have water in your world? Are you carbon based? So many questions rush into a persons head once they realize they are talking to an alien being.

On Earth Mr. Gans, the emphasis of the people who control the practice of pharmacy is simply to put as many pills as a prescription calls for in a bottle as quickly as possible, as many times a day as possible, while killing as few of our customers as possible, or at least deflecting their lawsuits. This means I am probably one of very few Earth-based pharmacists to have even seen your commentary. Most of my colleagues right now are simultaneously on hold, sending a fax, overriding a pointless DUR message, telling a customer where the cotton balls are while telling another for the love of God put that aspirin down because I just sold you a warfarin prescription. Many will do this for 12 hours non stop at a time. The only reason I saw your words was because I had a bowel movement which happily gave me the chance to sit down at work for a couple minutes. Somehow a copy of Pharmacy Today ended up next to the toilet seat.

Do you have spaceships that take advantage of Einstein's theory of relativity, the part that makes time travel possible? Do you fight Klingons?

All this effort, by the way, has recently been determined to be worth $4 for many prescriptions. Ask the people who control pharmacy on my planet what the biggest recent success in the profession has been, and they will tell you the ability to put pills in a bottle, as quickly as possible, while mostly not killing people, for $4. That is the definition of success in my pharmacy world.

What a wonderful place your planet must be. Even though I would surely die within seconds if I ever set foot on it due to lack of oxygen or a radically different atmospheric pressure, reading your words was like taking a soothing vacation to wherever this magical place you call home must be.

Perhaps someday here on Earth, we will have a leader in our profession who will be as effective at reshaping the practice of pharmacy as you have been on whatever planet you live. Perhaps we will have some sort of association that could lead us into this paradise of pharmaceutical practice. An American Pharmacists Association. That's what I'd call it if we had one. I'll bet if we had one of those that was worth more than a warm cup of spit we could actually have a little hope of making some constructive changes in our profession. The way you have on your planet.

Because Mr. Gans, if you lived on Earth and wrote those words and expected them to be taken seriously, I'd be laughing my ass off at you right now.

Saturday, January 23, 2010

I Can't Decide Which Of These Stories Is More Messed Up.

Both were sent in by alert readers, and for the life of me I can't decide which one wins the prize.

Candidate number one:

LOGAN, OH- A Logan man who admitted he tried to kill his wife by crashing their vehicle into a city of Logan "Gateway" column has died.

The Hocking County Sheriff's office confirmed Ross Nice, 73 died at Ohio State University Medical Center. He was admitted there on Nov. 24 for serious injuries sustained in the incident.

The sheriff's office had a warrant for Nice on two counts of attempted aggravated murder and planned to serve it after his release from the hospital. Nice was accused of first striking his wife, 52 year-old Bonnie Nice, in the head with a wrench and cutting her with a knife in an attempt to kill her.

Later the same morning, with his wife in the passenger seat, he intentionally drove their minivan off the side of Front Street, according to authorities, and into a cinder block column attached to one of Logan's gates welcoming people into the city with the message "Logan, Gateway to Ohio's Scenic Wonderland." He aimed the minivan so the front passenger portion of the vehicle took the force of the impact, authorities said.

His wife survived the attacks and was released from Grant Medical Center on Friday.

Candidate number two:

WARM SPRINGS, Ga. – A Georgia woman is in jail after police say she forced her son to kill his pet hamster with a hammer as punishment for bad grades.

The sheriff of rural Meriwether County told the Atlanta Journal-Constitution Thursday that the 12-year-old boy told his teacher about the killing. The teacher reported it to the Division of Family and Child Services, who contacted police.

Sheriff Steve Whitlock said 38-year-old Lynn Middlebrooks Geter of Warm Springs faces one charge each of animal cruelty, child cruelty and battery.

So, my first impulse is to go with the hamster. Fucking with your kid like that is pretty messed up. That boy probably ain't gonna be right in the head for like......ever. And the minivan thing is kinda funny and definitely karmic, which makes it feel less messed up.

On the other hand, hamster momma never tried to injure or kill a person. At least physically. And minivan man tried to actually kill his wife. Twice. Which really isn't funny. Unlike the fact his name was "Nice." That's kinda funny.

And what kind of person, after suffering a wrench and knife attack, says "Sure, I'd love to go for a ride with you?" That's pretty messed up.

I guess......I'm going with minivan man. I think the incompetence factor tips the scale.

But.... hamster Mom wanted her son to get better grades, so I guess she really cared about him, in an incredibly messed up kinda way.

My head is starting to hurt thinking about this.

At least I know now I really wasn't the world's worst husband, and I can be pretty sure I wouldn't be the worlds worst parent.

Friday, January 22, 2010

In All Seriousness, I Think Rush Limbaugh Is The Most Rational Of The Bunch.

I honestly believe Glenn Beck has mental health issues. Mark my words. It'll come out one day.

Bill O'Reilly just loves to shoot off his mouth to get attention. And money. And he knows the money for being an outrageous tool of the right is far better than for being a tool of the left. Good for him, bad for the country.

But I honestly believe Limbaugh is sincere. That he sees himself as a man fighting in the war of ideas and has a purpose beyond self ambition.

Apparently my Republican friends would agree, as last May, when asked "Who is the main person who speaks for the Republican Party today?" Limbaugh finished tied for first place among Republican respondents.

Remember that as you read this quote from Wednesday's show:

To some people, banker is a code word for Jewish; and guess who Obama is assaulting? He’s assaulting bankers. He’s assaulting money people. And a lot of those people on Wall Street are Jewish. So I wonder if there’s – if there’s starting to be some buyer’s remorse there.

You know another common meaning of the word "banker?" A PERSON WHO RUNS A BANK.

I believe he is sincere, but I also believe he made more sense when he was stoned. I'm going to stop yelling now. Because yelling just plays into his game.

More self-identified Republicans say that man speaks for their party than anyone else.

And you wonder why I hate them.

Wednesday, January 20, 2010

A Random Tribute To Pete Seeger

If your musical taste has never gone beyond the modern music machine that gives us American Idol and Lady Gaga, you're probably not a fan of folk music, and you may never have heard of Pete Seeger, which would be a shame for you. Pete is simultaneously the greatest  voice and last echo of the working man's folk music of the Great Depression, a last reminder of the time when This Land Is Your Land had all its verses.

"What are you talking about Drugmonkey? This Land Is Your Land? I've heard that song a million times"

But you probably haven't heard all of it. You've heard the sanitized version. The homogenized remnant that has been processed into mindless rah rah pap to be played on Disneyland's Main Street USA as Mickey Mouse™ walks by. The original was in your face political. A song of the working man who wasn't going to take being exploited by this country's self appointed economic elete much longer:

As I went walking I saw a sign there
And on the sign it said "No Trespassing."
But on the other side it didn't say nothing,
That side was made for you and me.


Nobody living can ever stop me,
As I go walking that freedom highway;
Nobody living can ever make me turn back
This land was made for you and me.


In the squares of the city, In the shadow of a steeple;
By the relief office, I'd seen my people.
As they stood there hungry, I stood there asking,
Is this land made for you and me?



That's how Woody Guthrie wrote it, and that's how Pete Seeger sings it to this day. An unapologetic leftist, he was blacklisted at the height of his group's popularity and dragged in front of Congress to testify before the House Un-American Activities committee, where he was asked about his past ties to Communists and pressured to name names of fellow travelers. Here's what Pete said:

"I am not going to answer any questions as to my association, my philosophical or religious beliefs or my political beliefs, or how I voted in any election, or any of these private affairs. I think these are very improper questions for any American to be asked, especially under such compulsion as this."

With those words Pete Seeger's music career had the knees knocked out from under it, and he was indicted for contempt of Congress. I'll leave it to you to decide which side was Un-American that day.

Pete spent the better part of the next decade in the wilderness, his ability to earn a living crippled while fighting a legal battle that at one point resulted in a sentence, later overturned, of 10 years in a federal prison. It took The Smothers Brothers to reintroduce Pete to a mass audience.

Yes. Those Smothers Brothers. They had a variety show during the 60's and fought a tooth and nail battle with CBS to have Pete on. While the existence of testicles on The Smothers Brothers may come as a surprise to those who see them today, there is no doubt Pete has an iron pair. At a time when it had not yet become fashionable to protest the Vietnam War, Pete got on national television after an exile imposed by the United States Congress and sang this to Mr. and Mrs. America.



"We were lucky to escape from the Big Muddy/When the big fool said to push on..." Kick-ass. Not to mention depressingly familiar.

Oh, and along the way, Pete Seeger formed Hudson River Sloop Clearwater, an organization that convinced people the Hudson River was crazy polluted and should be cleaned up.

I saw Pete Seeger not long ago. When I heard he was coming close I knew I would have crawled through mud and ice and snow and rain on my knees for miles for the chance to see him. Fortunately all I had to do was buy a ticket. He's 90 years old now, and he held that arena in the absolute palm of his hand. I wanted to wrap myself around him and make him stay forever, as I fear they just don't make his kind anymore. The fact I couldn't made me want to cry a little, along with the continued power of the songs I heard that day.

Pete won't be with us much longer. If he comes to your town I recommend crawling on your hands and knees to see him if you have to.

And don't ever forget the lost verses.



Tuesday, January 19, 2010

A Face Perhaps Only A Diabetic Could Love.



"LET ME TELL YOU RIGHT NOW....IF YOU DON'T GET ONE OF THESE MACHINES YOU ARE A GAUT-DAMMED MORON!! PICK UP THAT PHONE!!!

uggggghhhh.......where's muh fiber? I didn't see any of muh fiber in the dressin' room and I need my fiber.....

....and muh Zan-ax. I need two of muh Zan-ax today.

ugggggghhh.....where am I?

BUY A GAUD-DAM MACHINE!!!!!

ugggghhhhhhhhhh......ugh......ZZZZZZZZZZZZZzzzzzzzzzzzz........."

Monday, January 18, 2010

The Johnson And Johnson Story You May Have Missed

You've probably heard about the moldy Tylenol. And Benadryl. And Motrin. And Rolaids. Simply Sleep and St. Joseph's aspirin as well. Made some people sick it did. If I still had a cellphone I would have taken a picture of our over the counter shelves at the store after they pulled all the moldy Tylenol and the rest and plastered the recall notices up in their place. It would have made for a good addition to the pharmacy art picture series, but alas, I'm without a cellphone at the moment. Maybe forever. I've found I really don't miss it that much.

So how about instead of a wall of recall I post something from the Johnson and Johnson credo? They seriously have a credo. On their website they seem to be quite proud of it:

We believe our first responsibility is to the doctors, nurses and patients, to mothers and fathers and all others who use our products and services. In meeting their needs everything we do must be of high quality.

"...and not moldy." That's what I would suggest they add to the credo if I were a Johnson and Johnson shareholder.

Other than the mold loophole, however, I think the Johnson and Johnson credo is pretty solid. I like how they realize they should always put the interests of the people that use their products first. That makes me feel all safe and secure when dealing with Johnson and Johnson:

Federal prosecutors said Friday that health care giant Johnson & Johnson paid tens of millions of dollars in kickbacks so nursing homes would put more patients on its blockbuster schizophrenia medicine and other drugs.

What? But......the credo......

In a complaint filed Friday, prosecutors said J&J paid rebates and other forms of kickbacks to Omnicare, the country's biggest dispenser of prescription drugs in nursing homes. Prosecutors allege Omnicare pharmacists then recommended that nursing home patients with signs of Alzheimer's disease be put on the powerful schizophrenia drug Risperdal...
...Its complaint alleges the scheme went on from 1999 through 2004, a period when J&J's sales of drugs through Omnicare jumped from about $100 million to more than $280 million. More than one-third of that was sales of Risperdal.

Well it does say in the credo that distributors of Johnson and Johnson's products must have an opportunity to make a fair profit. Johnson and Johnson really must take that credo seriously.

Wait. Fair profit. I guess that rules out kickbacks. Nevermind.

By the way, Rispirdal was never indicated for use in Alzheimer's or any other form of dementia, and shortly after the kickback scheme, the FDA required a black box warning stating that using Rispirdal this way increases the risk of death. I think if I were a Johnson and Johnson shareholder I might also suggest they add "and we won't make dumptrucks full of money by increasing people's risk of death, or we'll at least act like we're sorry when we do" to the credo.

Or else I would maybe introduce a resolution just declaring the credo to be bullshit. Because when you're incompetent in manufacturing and unethical in your business dealings, there's no use being a liar as well.

Especially when the lying adds nothing to the bottom line.

Thursday, January 14, 2010

A Statement On The Haitian Disaster, And The Reaction You Could Be Excused For Expecting.

WASHINGTON DC- (Drugmonkey News Service) In remarks delivered today at The White House, President Obama pledged American aid to victims of the recent earthquake in Haiti, which is feared to have killed as many as 100,000 people and left many more thousands homeless and hungry as the impoverished nation struggles to cope with the disaster's aftermath.

"This morning, I can report that the first waves of our rescue and relief workers are on the ground and at work. A survey team worked overnight to identify priority areas for assistance, and search and rescue teams are actively working to save lives. Our military has secured the airport and prepared it to receive the heavy equipment and resources that are on the way. An airlift has been set up to deliver high-priority items like water and medicine. And we're coordinating closely with the Haitian government, the United Nations, and other countries who are also on the ground."

The president also added a message to the Haitian people:

"Few in the world have endured the hardships that you have known. Long before this tragedy, daily life itself was often a bitter struggle. And after suffering so much for so long, to face this new horror must cause some to look up and ask, have we somehow been forsaken?

To the people of Haiti, we say clearly, and with conviction, you will not be forsaken; you will not be forgotten."

Reaction from Congressional Republicans was swift.

"This president just does not seem to understand that earthquakes are vital, natural, processes necessary for the development of mountains and many of the other geographical features we have come to depend upon" said Senate Minority Leader Mitch McConnel at a press conference on Capitol Hill. "If it were up to this President we would surely be living in a mountain-free country completely free of elevation change. Altitude is a vital part of America, and I want the American people to know The Republican Party is squarely on the side of diversity in the landscape."

Criticism of Obama took place outside of Washington as well.

"Do you know who else expressed sympathy for earthquake victims? HITLER!!!!!!!!" said Tea Party activist Jeffrey McQueen in an interview outside his home. "He released a statement of condolence to the Japanese people after the 1933 Sanriku earthquake. As someone of partial Jewish heritage I'm more than a little concerned about the similarities."

"Think about it" McQueen sneered before slamming the door in a reporter's face.

On his television program "The 700 Club" televangelist Pat Robertson took issue with the declaration that the Haitian people are not forsaken.

"Something happened a long time ago in Haiti and people might not want to talk about," Robertson said Tuesday.

"They were under the heel of the French, you know Napoleon the third and whatever. And they got together and swore a pact to the devil. They said 'We will serve you if you will get us free from the prince.' True story. And so the devil said, 'Ok it’s a deal.' And they kicked the French out. The Haitians revolted and got something themselves free. But ever since they have been cursed by one thing after another," Robertson said.

In the Haitian capital of Port-au-Prince, people not in the process of a slow agonizing death trapped under tons of rubble appeared baffled.

"They are not contagious are they? The crazy Americans?" said resident Jean-Claude DuPassant. "Perhaps I should wash my packet of aid before I open it."

Parts of this story not made up:

-The Obama quotes.

-Teabagger Jeffrey McQueen saying his partial Jewish heritage makes him concerned about President Obama's similarity to Hitler (it's at around the 11 minute mark if you click on the link & listen)

-Everything here about Pat Robertson, who finished second in the 1988 Iowa Republican presidential caucus, ahead of George H.W. Bush.

Tuesday, January 12, 2010

My Exclusive Interview With The Antibiotic Doryx.

Me: Thanks for making the time to come in today Doryx, I know you're a busy drug.

Doryx: Thank you for having me Drugmonkey, and for the opportunity to explain why my unique enteric-coated pellets of doxycycline hyclate means there is no substitute for me!

DM: Meaning if your doctor writes a prescription for Doryx, it cannot be filled with any other type of doxycycline.

DOR:That's right!!

DM: What did people do before you came to market?

DOR: Well they didn't get the benefit of my unique enteric-coated pellets, that's for sure!

DM: No, seriously, what did they do?

DOR: Got by with outdated versions of doxycycline the best they could I suppose.

DM: And did these old fashioned versions of doxycycline have some sort of problem with bacterial resistance, or another sort of effectiveness problem that necessitated your invention?

DOR: My niche is more on the safety side Drugmonkey, you see, my enteric coating means I don't start to dissolve until I pass though the low pH environment of the stomach and into your intestine, and if I don't start to dissolve until I pass through your stomach, the chances of me triggering stomach cancer and leading you to a slow agonizing death would seem to be almost nil. Did you know stomach cancer has one of the lowest survival rates of any malignancy?

DM: Are you saying other forms of doxycycline cause stomach cancer?

DOR: Well I'm not in a position to comment on what other doxycyclines might or might not do. All I'm saying is that I never touch your stomach. I also contain no uranium, which means the chances of me becoming fissionable material and triggering a thermonuclear reaction are pretty much zero.

DM: So Doryx could be an integral part of a nuclear-free world?

DOR: Absolutely.

DM: I see. So while we're on the subject of safety, do you cause less fetal harm if given to a pregnant woman than regular doxycycline?

DOR: No.

DM: Less photosensitivity?

DOR: No.

DM: Less Clostridium difficile associated diarrhea?

DOR: No.

DM: Less....

DOR: Look, I'm enteric coated, OK? I think the benefits of that would be self-evident.

DM: So self-evident that it's not really necessary to do any actual scientific studies to quantify what these benefits might be?

DOR: There are limited research dollars for these type of things you know. I think we can all agree that our resources are best spent elsewhere.

DM: Speaking of limited dollars, you are aware that a month of Doryx therapy can cost over $400?

DOR: I'm glad you brought that up Drugmonkey, the people at Warner Chilcott, who make me, are very concerned about the impact of high drug prices on patient care. That's why we've developed the Doryx Savings Card program. Once enrolled in this program, a patient will pay no more than $25 dollars for a Doryx prescription, cutting the retail price by over 90%!! Those are real savings for real people.

DM: For the first three months.

DOR: Well, yes.

DM: And with how you've positioned yourself as an acne medication, as opposed to an antibiotic to treat acute infections, you expect most of your customers to take you for far more than 3 months, don't you?

DOR: Unless they want their zits to come back and end all their chances of ever being accepted by the cool kids in school.

DM: And you know a month of regular doxycycline costs less than $15.

DOR: Look, I know our time is running short here, but ask yourself, if your tumor-laden stomach were to explode in a toxic mushroom cloud, how much would you have paid to prevent that? There are some things you just can't put a price on Drugmonkey. Thanks again for having me on.

DM: We.....um...actually have plenty of time left.

Doryx bolts out of the studio......


____

Disclaimer: There is no link between any form of doxycycline and stomach cancer. That was just a fictional example of the kind of bullshit I imagine Doryx would say if it could talk.

Monday, January 11, 2010

From The Mailbag: A Reader Writes In To Prove That A Texan Can Be Both Thoughtful And Articulate. And That I Am Like Hitler.

Got this in response to my explanation of the theory that global warming could lead to a breakdown of the North Atlantic saline pump, and subsequently to the slowing of the Gulf Stream, resulting in Europe getting colder as the rest of the planet warms, which was attached to a post that included insinuations that southerners in general and Texans in particular are a little dumb:

Straight out of Texas, you bitch ass, size envy having hatchet wound...suck my "texasshole" you Pansy ass twat wig.

Well I guess that just proves the whole saline pump theory wrong now doesn't it?. In some alternate teabagger universe that is, the center of which is probably Houston. I stand corrected.

My right wing intellectual friend also had this to say:

Never understood knocking a whole region or group of individuals, Hitler did, I just don't.

Which indeed makes you a better person than Hitler. You and everyone else who isn't responsible for the industrial scale killing of 6,000,000 people in death camps and another 60,000,000 or so in a war you started. Congratulations. You, Lou Dobbs, The Unabomber, and Osama Bin Laden are all better people than Hitler. Nothing like setting your goals high and then striving to achieve them. You have much to be proud of sir.

Despite the fact you're from Texas, the asshole of the United States, and, not coincidently, the home of George W. Bush.

Not to mention ZZ Top.

Monday, January 04, 2010

I've Spent A Lot Of Time Telling You About Big Pharma Pud Sucking. It's a New Year. Maybe I Should Spend Some Time On Little Pharma.

Tiny Pharma actually. Microscopic Pharma almost. Specifically, the "custom compounding pharmacies" that have proliferated, in the rich parts of town, over the last 20 years or so.

"Oh, here's where the Drugmonkey tells us how we are the last bastions of the profession, keeping the flame of pharmacy alive as it comes under assault from the chain corporate beast who envisions the profession as nothing more than a glorified fast food cashier. Yay Drugmonkey!!" The proprietors of these compounding pharmacies are saying to themselves.

Except that's not what I'm going to say. Not even close.

Now there's nothing wrong with a lot of what these places do. Like the name implies, they butter their bread by making specialized preparations of things not commercially available. Odd strengths of prescription meds, making a liquid when there is only a capsule on the market, capsules when there is only liquid on the market, unique flavors so your pet and/or child can get their medicine down. Some of their work is actually laudable. Some of it is simply catering to the more money than brains demographic, so the affluent and stupid can say things like "MMMYYY Prozac is custom made just for meeeeeeeeee!!!! Because I am a special person who can take neither 10 nor 20 milligrams. Neither can someone of my social status be expected to break a tablet in half. So I shall pay 3 times as much as you for my meds. Because I am rich and special and you are not. " Which isn't really laudable, but is kinda funny and karmic.

Then there are the products that take advantage of the loophole that these compounds don't have to be proven effective. Like the promethazine gel this month's Pharmacist's Letter says hasn't been proven to be absorbed or to actually work. That's neither funny nor karmic.

Oh but it gets worse. Many of these places have built up a good part of their business hawking "bioidentical" hormones. Estrogens and such. When I first made my break for the coast I interviewed with one of these compounding places, and as part of his recruiting package, the store's owner handed me the brochure he gave to customers asking about his "bioidentical" estrogens. They were the exact same hormones found naturally in your body it said, and stated unequivocally that therefore his compounded stuff was safer than commercial products such as Premarin and Prempro. There were no studies that backed this up that I was aware of, so I asked the owner on what basis he was making this claim.

"The amount of money I make on the compounds" was his reply. Which was merely unprofessional back then.

Today however, we know there is an undisputed link between estrogen exposure and breast cancer. We know that the number of breast cancer cases fell almost immediately when this news broke and doctors backed off on the estrogen prescriptions. 

"But our stuff is different!!! Say the compounders."It is natural and bioidentical!!"

Except that we also know that women who have a higher lifetime exposure to estrogen naturally, such as those who started their menstrual cycles early and/or ended them late...also have a higher than average risk of breast cancer. Which would imply the "bioidentical" stuff really isn't all that different as far as the breast cancer goes.  If you have a pharmacy license you should know this. If you don't you are negligent and should be out of our profession. If you do, and are marketing these things anyway by implying they are safer, in my eyes you are criminal, and belong in jail.

Because loving your money more than your mother should most definitely be a crime.