Thursday, November 18, 2010

My Last Post

My first blog entry was June 24, 2007. In the 3 and 1/2 years since that first post, I've experienced a whole lot of life. While my original intentions for writing this blog were to entertain, it quickly evolved into a form of self-therapy. I looked deep inside myself to figure out what I really wanted in life. I explored the darkest emotions and analyzed past events repeatedly until I covered every conceivable angle. In the process I learned about not only myself but also the world in which I live.

In 2007, I was a 25 year old kid. I had no idea what I wanted. I was less than a year out of school. I still wasn't certain if I could cut it in the pharmacy world. I still viewed the world through the immature eyes of a child. There wasn't a single area of my life with which I was at peace, and I couldn't find a direction in life that would provide me with peace. Lost is easily the best way to describe my situation.

Over the following 2 years, I attempted to build up a life which could bring me some satisfaction. I took more responsibility at work. I attempted to make more friends and go out whenever the opportunity presented. I was determined to not let the breakup with my ex-girlfriend stand in the way of my future love life, so I even ventured as far as to try an online dating service... twice I might add.

I took the suggestions of friends and readers who commented on my posts. I made what many self-help gurus would say were healthy attempts at picking up the pieces of my life and moving on. However, no matter how hard I tried, my life always came crashing right back to square one.

The reason for the repeated crashes didn't occur to me until much later. My foundation wasn't solid. I was trying to build a life upon a flawed and shaky foundation. Therefore, no matter how many times or how many techniques I would try to build up to a higher and happier place, that faulty foundation would always cause my efforts to collapse back to ground level. I realized that the only way I could get to a better place was to start all over again and build my entire being from scratch.

In order to do this, I had to really analyze who I was and what brought me the small slivers of happiness that occasionally pierced the ever-present darkness in my life. I had to decide what, if anything, I wanted to believe in, and what were my core values. Anything that didn't fit in with those beliefs and values had to be removed from my life.

Everything was eligible for the chopping block. Family, friends, work, basketball... absolutely everything. I had to figure out the key components of that solid foundation I desperately needed. The first thing that went were most of my friends. People, who upon deep reflection, didn't value me as a person and whose lifestyles didn't mesh with my own interests and values were removed from my life. I knew that I wasn't a guy who was interested in going out partying and getting drunk, so any of my friends who thought the best use of their free time was to hit up a club and get wasted weren't going to fit into the life I wanted.

The next important step was deciding the best use of my free time was to get in shape. Having been an athlete for most of my life, it always upset me that I had put on 20+ pounds of mostly fat since the end of high school. No, I wasn't fat by any stretch of the imagination. However, I knew that I was out of shape. I knew that my diet of pizza, pretzels, beer, and cookies wasn't healthy for me. Objectively I knew that exercise and eating properly are far superior to any anti-depressant medication for lifting one's mood, but I was always too lazy to maintain a workout plan.

I educated myself on how to eat properly. I participated in online health and fitness forums in which knowledgeable posters showed me the evidence that proved that most of what I had known about nutrition and fitness was incorrect. I learned how to exercise efficiently. I learned how to eat a balanced diet, and more importantly, I learned the differences in the way our bodies metabolize different nutrients. Understanding the difference between high and low glycemic index carbohydrates and learning the fallacy of low fat diets enabled me to make great progress towards cutting weight and getting into good shape.

In less than 6 months, I shed 17 pounds (mostly of fat) and greatly increased the strength and efficiency of my muscles. I went from barely being able to do 3 pull-ups to being able to do sets up 8 reps with 35 pounds of weight strapped to me. Through high intensity interval training, I increased my cardiovascular endurance to the point where I could play basketball for 3 straight hours and barely feel winded. I brought my mile-run time down under 6 minutes for the first time since I was in middle school.

Besides the physical benefits of being in-shape. The absolute best part was that I felt happier. I didn't stress out as much. I found it easier to remain calm. I had more energy to do more things in my free time, and that led me to be in better spirits most of the time. It was wonderful.

Being in an almost perpetual good mood allowed me to finally come to terms with my, what many people would call depressing, beliefs. I knew I didn't believe in any organized religion. I knew I was a strict science and logic guy. There's no heaven. There's no hell. Human beings aren't a part of some big plan, but rather an evolutionary accident that will some day vanish from the earth just like virtually every species throughout all of the planet's lifespan has done and will do. Life will continue to thrive on this planet long after humans are extinct. We will ultimately be forgotten by the universe and nothing we ever did or will do will ultimately matter.

With that in mind, I don't believe in angels. I don't believe in demons or ghosts. I don't believe things are "meant to be," and there is no divine plan. I believe praying does absolutely nothing besides provide a placebo effect (and even that is being shown to be untrue by newer studies on the subject). Moreover, as I've noted before in this blog, prayer is kind of a stupid notion because when you break it down logically, it makes no sense at all. I don't believe everyone is special. I don't really believe anyone is special. We're all just kind of here entirely by accident, and we're all going to die sooner or later.

Depressing, right? I know. I struggled with it for a long time. It's hard to come up with a reason to go on when you don't believe there's any real point to all of this. It all just seems so unimportant, and objectively speaking, it isn't important at all.

However, in my fitness induced good-mood I had a moment of clarity. Why does there have to be a purpose? Who cares if we live a few decades and die without leaving any real lasting impression on the universe? The funny thing about human intelligence is that we're the only species in the entire history of the planet who could even care about a meaning to life. For a billion years, life has been rolling along. Each individual life form lives out it's comparatively short life-span, and the cycle just keeps going.

Maybe the point of life is simply to live. In that way, no living thing is any more special than any other living thing. However, the simple fact that we're alive makes us all special. In case, you haven't noticed, life is pretty rare in the universe. The chances of the right compounds being present in the right environment for the chemical reactions of life to start are very very slim. However, right here on Earth, it happened, and in that sense, we've hit the universal lottery. Our mere existence is incredible. In my eyes, that's all the reason I need to live.

That was the last piece of my foundation. I knew it was a solid one because it came entirely from myself. No part of it was unconsidered or handed down from a parent or other authoritative figures in my life. It was my own.

From there, I could slowly start building up the life I wanted without excessive worries or expectations. I was finally content, and that happy feeling allowed me to finally pull my heart away from my ex-girlfriend and open it up to someone new. As I've said before, I'm not happy because I have a girlfriend. I have a girlfriend now because I'm happy. She didn't save me, and if this relationship doesn't work out, it won't ruin me either. I saved myself, and my happiness is completely derived from myself.

That brings me to the end of this blog. The previous 325 posts have helped me accomplish everything I wanted to when I wrote that first post in June, 2007. It was important to me in ways, despite all my analysis, I'll never fully understand. I thank everyone who has ever read my blog, and I especially want to thank those who took the time to comment on my posts (regardless of whether the comment was positive or negative, whether it agreed or disagreed with what I was saying). Whether you realize it or not, your shared in my strange, enlightening, and often times frustrating journey. I was a kid when I started this blog. Now I'm nearly 29 years old, and now I'm a nearly 29 year old man with a renewed sense of self. I'm sure if you go back and read my earlier posts, the change in tone is very noticeable. Looking back, it's actually quite fascinating to see how my mind was working at each stage of my metamorphosis.

The blog will remain up for a little while I try to back up my posts. I've written nearly 1,000 pages here. I'm not just going to throw them away. However, once I get everything archived, I'm taking the blog down. I'm sure this won't be the end of my writing. I like to write, so I'll continue in one form or another, but it won't be here. Maybe I'll start up a new blog. I'm keeping my options open.

(Typical of my writing style, this last post was incredibly long-winded. I'll apologize one final time for writing too much.)

Tuesday, November 9, 2010

This Free Antibiotic Bullshit Has to End

I'm so sick and tired of free antibiotics. It is the most pointless promotion in business history. ALL BUSINESS. I'm not even talking about just pharmacy here. I challenge you to come up with a dumber business strategy than handing out free antibiotics.

Free antibiotics have not increased our script volume. They have not increased our sales of OTC medication. They have not brought in new loyal pharmacy customers. The only thing they have accomplished is decreasing our gross margin.

It hasn't even made our community healthier. If anything, we've jeopardized public health by promoting wide spread use of antibiotics when not really necessary, which could in turn increase the growth of antibiotic resistant bacteria.

I've hated this program the entire time we've been running it. However, the tipping point was last Friday when I heard the store manager bitching about my flu shot table. You see... I have a table set up in front of the pharmacy where I set up all the stuff I need to give flu shots. While I'm working at the pharmacy, I keep a flu shot sign, a box of gloves, bandaids, and gauze pads on the table. I used to keep the sharps container there too, but the store manager said it could be a safety hazard, so I now keep it behind the pharmacy counter and carry it out with me whenever I have to give a shot.

The store manager never really liked my flu shot table from the start. However, the company was actively promoting flu shots and had signs up all over the store, so he didn't really contest its presence. Apparently, my employer thinks that the end of October marks the end up flu season, and it pulled pretty much all of the flu shot advertisements. The new signs that went up were all promoting the free antibiotic program.

Since the flu shot signs came down, my store manager thought that it would be a great time to voice his disapproval of the table. On Friday, he asked how much longer it would be there and complained that it was just taking up space in front of the pharmacy (as if they were going to use it for something more constructive).

This seriously pisses me off. The store goes all out promoting this moronic free antibiotic program that does nothing but piss away money. However, when it comes to flu shots that actually net us a very decent profit, it can't wait until I stop giving them. To reiterate, the store promotes a program that can endanger the public by spurring the growth of resistant organisms, but it pushes aside a program that helps to prevent illness and saves the health care system money.

As much as I disagree with my employer's policy on free antibiotics and the rampant use of gift cards to promote the pharmacy, my store manager is the one that really draws my ire. He's such an arrogant bastard. He constantly wants to know what our sales numbers look like for the week, and if we report a low figure to him, he acts like it's because we're just not working hard enough. It's our fault we're not generating a lot of revenue. It has nothing to do with the company's policy of giving our most popular drugs away for free.

Last week, we actually did fairly well sales-wise. Upon hearing our figures, he sarcastically applauded us and couldn't resist mockingly saying, "it must be all the flu shots."

Fuck you, you arrogant prick. What have you done that's so fucking great? From my view point, you mostly stock shelves all day, and just like every other store manager we've ever had, you'll only be around for another 5 or 6 months before corporate ships you off to another store. Store managers are a dime a dozen. They're entire job is to make the store look neat and to otherwise act as a bitch to the corporate offices. They don't think on their own. They don't enact policies or promotions. They just follow orders.

Therefore, this glorified grunt worker mocking my professional services is a real fucking joke. I haven't given out a ton of flu shots in the grand scheme of things, but I am over 100 for the season so far. That's over $1,500 of pure profit that only I could bring in. There are no other immunizers in my store. It's just me, and if it weren't for my flu shot table, that $1,500 would be in Walgreens' or CVS's pocket and not ours. Maybe it's not a lot, but it's more profit than our current store manager has ever been solely responsible for producing.

Since, I'm back on the subject of profits, let me further illustrate how ridiculous these free antibiotic and $4 generic programs are. They're actually amazing in that at the same time they are decreasing our profit margins, they are increasing drug prices. Yes, that's correct. Instead of making drugs more affordable for patients, they are actually raising costs (and decreasing the quality of pharmacy services I might add).

North Dakota has a law that stipulates that all pharmacies must be majority-owned by a licensed pharmacist. Obviously, CVS, Walgreens, and the other major chains don't like this law because it excludes them from opening pharmacies in North Dakota. Therefore, they've attacked the law saying that North Dakota is depriving its residents of the cheaper drug prices that the major chains can provide (in the form of $4 generics and free antibiotics).

Well, in January 2009, the Institute for Local Self-Reliance showed this not to be true. In fact, it concluded that repealing the law "would cost the state millions of dollars in annual economic activity and tax revenue, dramatically reduce the number of pharmacies serving rural areas, and degrade the overall quality of pharmacy services in the state."

Among the report’s key findings is that rural areas of the state have far more pharmacies and greater access to these vital health care services than is found in other states. Census tracts with 2,001-3,500 people in North Dakota are 31% more likely to have a pharmacy than those in South Dakota. And, while only one-quarter of census tracts with 1,001– 2,000 people in South Dakota have a pharmacy, nearly half of those in North Dakota do.

The report also mentioned how North Dakota has prescription prices that are well below the national average, and how repealing the law would result in a net loss of $23 million per year in direct economic benefits.

The moral of the story is that maybe big chain pharmacies should reconsider their pricing habits considering the one place in this country that doesn't make a habit of giving shit away for free is the one providing the best care and making decent profits at the same time.

Baby steps though. Let's start slow. Just get rid of the stupid free antibiotics.

Thursday, October 28, 2010

"We Made the Mistake. You fix it."

At least that's what one medical assistant wanted us to do today.

Two weeks ago, the office called in a prescription for the wrong dose of Metoprolol. The patient was supposed to get 50 mg, but the office called in 100 mg. By the time the patient realized the mistake, he had already picked up the medication and started taking it.

Today a medical assistant called up and informed us of the mix up. She told us that it was supposed to be for 50 mg. Then she stated that the patient will be returning the 100 mg tablets and exchanging them for the correct ones.

I quickly corrected her by saying, "we won't be exchanging the prescription. It's against federal law to take back medication once it has left the pharmacy. It's been 2 weeks. The patient will have to pay another copay."

"You won't take it back?" she exasperatedly asked. "Other pharmacies have taken medication back before. You're going to force her to pay another copy?"

Now, I was a little pissed off. "Is that how it works?" I said. "You guys make the mistake, and we end up footing the bill for it? YOUR error prevents US from getting paid? Does that make sense?"

She paused for a couple seconds before saying, "well, I'm not going to argue with you." Then she hung up.

If this was an isolated incident, it would be one thing. However, it's something that happens quite often. The people working in doctors' offices seem to forget that we actually have to buy the drugs before we can sell them to people. Therefore, when they tell the patient that the pharmacy will simply do an exchange to make up for their mistake, they forget that the pharmacy ends up being the loser.

The only time I pull this exchange bullshit is if the error is clearly ours. If we make the mistake, well, that's our fault, and we'll do what we have to in order to correct it. If the doctor's office makes the mistake, and the patient ends up having to pay a second copay because of it, I'll often tell the patient to go ask the office for a refund of their wasted money. The pharmacy already gives away so much. There's no way I'm wasting more money when we had nothing to do with the error.

Tuesday, October 26, 2010

Is It OK to Have Secrets?

For the past 2 weeks, I've been wrestling with the thought of whether it's OK to keep some parts of your life separate from your significant other. I guess I've hit the point where I need some advice, so it's finally making it's way to a blog post.

To cut straight to the point: My girlfriend doesn't know I write this blog. She has no idea that I'm Pharmacy Mike or that Pharmacy Mike even exists. This blog has been a window into the inner workings of my mind. Therefore, in order to truly understand me, one would have to read my blog.

It's sad, but my readers know me better than my girlfriend does. My question is whether that's OK? If I'm in a committed relationship with this girl that someday might end up in marriage, am I obligated to tell her about this blog? Does she need to know?

Whether she needs to know or not is really the crux of my pondering. Do committed couples have to share every last details of their lives together? Should they be privy to their significant other's every thought and feeling? Or are there somethings that can be kept private in order to spare feelings?

I used to think that every person needs a little bit of privacy, but now I'm not so sure. It's not exactly like I'm overtly hiding anything from her. I've just never been comfortable divulging every thought that pops into my head. I usually don't speak without carefully considering the consequences of every word I might say. Moreover, every action I take is done so after great deliberation. Nothing I say or do is spontaneous. Nothing is unplanned.

I may say and do all the right things in this relationship, but sometimes I feel that I'm not being genuine. While it may not necessarily change my eventual action, I feel that the action is somehow less important than the inner monologue that leads up to that action. Without letting her in on what I'm thinking, I'm keeping her at an arm's distance. A big part of me thinks she deserves more honesty than that.

However, another part of me thinks that a lot of my thoughts and actions could be misinterpreted. For example, even though she knows about my ex-girlfriend and the basics about what happened, she doesn't quite understand the depth of my despair and how it took 4 years to be OK with everything that happened. Does she need to know that stuff?

I question where our relationship is heading, and what the next step will be. It bothers me that despite being together for almost a year now, she still has no plans or desire to move in with me any time in the near future. Moreover, even if we wanted to live together, I struggle with the logistics of our jobs being over an hour apart. I feel like we're both waiting for the "right time," but what if we never find the right time. Then we have to go and make the time.

I see that as a potential problem because I'm pretty much settled where I am. I own a condo and have a high paying job. Rationally, if one of us were to move, it shouldn't be me. However, how can I ask her to move here and be an hour away from work? Even though she doesn't really like her job and would like to find a new one, in this economy, how could I expect her to leave her job without another one lined up?

I have so many questions and concerns, but I feel like bringing them up will rock the boat and possibly ruin a good thing. Therefore, they remain mostly as an inner narrative. I act as positive as I can in order to mask my doubts. I do this to protect both of us, but am I actually doing more harm than good?

See, this blog is just one of the many things I keep to myself. Should I open up and share my innermost thoughts with this girl, or is it fine and maybe even normal to keep some things to myself? If I were to open up, I think it would make sense to let her know about this blog first. Of course, that brings to light a lot of things about my past that she'd probably rather not read. However, those things are part of who I am, and it would be nice to no longer have to hide from them. It could be liberating.

My question to my readers is simple: Should I let her know about this blog, or can I keep it to myself?

Monday, October 25, 2010

Saturated Fat and Dietary Cholesterol Are Not the Enemies

This post is in response to Harry's comment on my last post. He wanted more information about how saturated fat isn't evil.

Dietary cholesterol from animals and dairy products has a very small effect on blood cholesterol levels. One can expect dietary cholesterol, no matter how poorly one eats, to make up for roughly 15% of blood cholesterol.

This makes sense. Think about the drugs that block intestinal absorption of cholesterol, like Zetia. Zetia lowers cholesterol levels by roughly 10% to 15%, which is about what would be expected if you blocked dietary cholesterol.

Moreover, as pharmacists and other medical professionals are learning, there's not much evidence to show that Zetia has any mortality benefits. We know from Merck's very own trial that Vytorin does not decrease mortality or reduce plaque size any better than simvastatin alone. In fact, there was a small (but insignificant) increase in plaque size in the Vytorin group.

Enormously high cholesterol levels are still bad for you. However, these levels are are due to the body's overproduction of cholesterol, which is where Statins come in. Statins have established mortality benefits, and they work by decreasing the body's endogenous cholesterol production.

(As an aside- Statins also are known to have antioxidant and anti-inflammatory effects, which may also play a huge role in their reduction in mortality. Clearly, when it comes to Statins, lowering cholesterol is only part of the story.)

Now, the question becomes why does the body produce lots of cholesterol. Well, in some people, there'a genetic predisposition for it, i.e. homo- or heterozygous hypercholesterolemia. In other people, the body produces high levels of cholesterol due to our poor diets.

As is well known, cholesterol is vital to the body. It plays an important role in cell membrane integrity. It also acts as an antioxidant in that it cleans up free radicals.

Consuming a diet high in processed sugars, trans fats, hydrogenated oils, and rancid fatty acids, our bodies produce more cholesterol. Some of it acts to help clear up our bad diet. However, some of it gets clumped up into the mess and ends up leading to blocked arteries. In this way, high blood cholesterol is more a marker for disease than disease itself.

As for saturated fat...

Modern research is finally starting to shed some light on this too. The following quotes are taken from Wikipedia (which despite what some may say isn’t a bad source for quick information. Obviously, I wouldn’t use it if writing a formal report, but most of the information is from valid sources that are cited in the articles):

In 2010, a meta-analysis of prospective cohort studies including 348,000 subjects found no statistically significant relationship between cardiovascular disease and dietary saturated fat.[8][9]”

“In 2009, a systematic review of prospective cohort studies or randomized trials concluded that there was "insufficient evidence of association" between intake of saturated fatty acids and coronary heart disease, and pointed to strong evidence for protective factors such as vegetables and a Mediterranean diet and harmful factors such as trans fats and foods with a high glycemic index.[10]. Pacific island populations who obtain 30-60% of their total caloric intake from fully saturated coconut fat have low rates of cardiovascular disease.[11]”

“Mayo Clinic highlighted oils that are high in saturated fats include coconut, palm oil and palm kernel oil. Those of lower amounts of saturated fats, and higher levels of unsaturated (preferably monounsaturated) fats like olive oil, peanut oil, canola oil, avocados, safflower, corn, sunflower, soy and cottonseed oils are generally healthier.[13] However, high intake of saturated dairy fat does not appear to increase the risk of cardiovascular disease.[14]”

We all know this information to be true, but we’ve been mislead so long that we have trouble accepting it.

Here’s another article that contains some interesting information: “”

I’ll just briefly mention a bit from the article about the Masai, a nomadic tribe in Kenya and Tanzania that were studied in the 1960s. They got 60% of their calories from fat and half of that was saturated fat. Despite this, they had an incredibly low incidence of coronary artery disease and very low cholesterol levels. However, when some tribe members moved to Nairobi and began eating a more modern diet, cholesterol levels sky rocketed, despite the reduction in saturated fat.

There are so many other cultures that we wonder how they could eat what they eat and remain so healthy. The French are a classic example of people who eat loads of butter and other sources of saturated fat, and they are some of the healthiest people in the world, and that’s even with them smoking far more than we do. The Japanese eat plenty of shrimp, seafood , and other foods that are very high in cholesterol and saturated fat, and they have a low incidence of heart disease.

When you start piecing the evidence together, it becomes readily apparent that the common medical belief that saturated fat and dietary cholesterol is bad for you is simply wrong. Eating healthy basically comes down to eating whole wheat carbohydrates in place of processed and added sugars. Eat plenty of vegetables, some servings of fruit, and grill, bake, or pan-sear your meats as opposed to frying them. Appropriate portion sizes are also important. It doesn’t matter what you eat if you eat so much of it that you’re 50+ pounds overweight.

It sounds so simple, right? It would be if we weren’t so addicted to high glycemic index sugars and fried food. It’s harder to quit sugary and fried food than it is to stop smoking. Just try, and you’ll see what I mean. It’s an addiction, and it’s very very hard to break. I know how unhealthy this stuff is, and I still have a lot of trouble giving it up, especially when society is not on the same page. If you want to quit smoking, there a bunch of nicotine replacement products and self-help classes you can take. If you want to stop eating junk food, people look at you like there’s something wrong with you, especially if you’re not overweight. When a group of people get together and order a pizza, it’s just about impossible to be that one person who chooses not to eat it for health reasons. Eating these kinds of food are a personal problem, but it’s also a societal problem. Since society is doing nothing to help people change their eating habits, most people will not be able to do it on their own, even if they knew how unhealthy they're being.

Anyway… that was my long-winded explanation as to why saturated fat and dietary cholesterol is not bad for you. You can do more research on your own, and in doing so, I’m confident you’ll come to the same conclusion. It’s the one that makes the most sense. It’s funny how good science usually makes sense.

Saturday, October 23, 2010

I Hate Recommending OTC Meds

"I have a cold. What can I take for it?"

I get this question at least once a day, but I never feel comfortable answering it. It's not that I don't know how to treat common cold symptoms. I just don't know how to explain to people that the answer isn't necessarily in one medication bottle.

Whenever people ask for a recommendation about what to take for a cold, the first question I always ask is what symptoms they have. I can't make a proper recommendation without knowing what symptoms I'm trying to treat.


Great... I'll always follow up by asking whether the cough is productive or dry, but the answer doesn't really matter I suppose. By this point, we all know that dextromethorphan does absolutely nothing to relieve coughing. Therefore, all OTC cough suppressants are ruled out. For productive coughs, most pharmacists will recommend Mucinex. However, if we're going by evidence, there's not much evidence that guaifenesin loosens up mucous, so I always hesitate before making that recommendation.

According to the American College of Chest Physicians, acute cough should be treated with a first generation antihistamine, like clorpheniramine, and pseudoephedrine. They also say naproxen can be used to help reduce cough. Nowhere in the entire executive summary of the cough guidelines does it mention guaifenesin, dextromethorphan, or any opioid cough suppressant for that matter. There's very little evidence that they actually reduce cough.

How do you explain that to a customer though? When there are dozens of products in the OTC aisle that say "cough and cold" on the box, how do you explain to people that most of them are unlikely to reduce cough? You have to see the looks customers give me when I go out in the aisle and grab a box of store brand "Allergy Medication" (containing chlorpheniramine) as a recommendation to reduce cough. They think I'm crazy.

Moving away from cold medication... People often ask about vitamins. "What brand multivitamin should I take?" is a very common question. My response: You probably don't need to take a multivitamin.

People have this obsession with vitamins. They think they're the answer to all their ailments. However, in most cases vitamins are a waste of money. Unless a doctor diagnoses you with a specific vitamin deficiency, there's really no need to take a multivitamin. In fact, a recent large study showed that taking antioxidant vitamins not only didn't increase life expectancy and reduce the incidence of diseases like cancer, but people who took them actually had a 16% increase in mortality.

The modern diet, as poor as it might be in terms of overall health, usually provides enough of all the important vitamins to stave off any deficiency condition. About the only vitamin that a normal person might need to supplement is Vitamin D, and that's because we lather sunscreen all over ourselves, and sunlight is needed for the body to produce Vitamin D. Otherwise, if you aren't malnourished, you probably get plenty of vitamins in your diet.

You can show people a million studies on this stuff, but they won't listen. It's ingrained in their minds that vitamins are good for you and Robitussin is a great cough medicine, and there's nothing you can do to change their minds. After all, it must be true; they saw it on TV!

Or if they didn't see it on TV, their doctors said it was true, so it must be. You ever try to convince someone that what their doctor said is entirely incorrect? It's very difficult, especially when just about every doctor says the same thing.

For example, every doctor tells you to avoid saturated fat and cholesterol like the plague... and every doctor is wrong. No matter how hard I try though, I'll never get those health nuts to go back to drinking whole milk and eating whole eggs instead of just egg whites.

The problem is that conventional wisdom is murky at best instead of scientifically tested truth. Since I know that the evidence is quite shaky, I can't in good conscious recommend what others would without batting an eye. Therefore, I've come to dislike the part of my job that involves counseling on OTC meds.

I'm my employer's worst nightmare in this regard. I actually prevent more OTC sales than I facilitate. That can't be good for business even though what I say is backed by the most current scientific evidence. That's why I'm so happy to be promoting flu shots. Flu shots are the rare occurrence in pharmacy where what's best for the patient is supported by science and good for our business.

Tuesday, October 19, 2010

I Don't Work For Free

"Glad to know the employer is making money off of the pharmacists training and risk. When will pharmacists learn no to give their talents away?

We have already labeled ourselves as less than human by working long hours with no breaks or lunches.

Bad for the profession..Stand up for yourselves. Shame on you."

This statement was a response to my post about how I love to give flu shots. I disagree with it.

For one, there is very little risk involved in giving flu shots. Most people don't have any significant adverse reactions to them. Moreover, there's not much technique involved in giving one. You simply take the syringe and stick it in someone's shoulder muscle. It's really hard to mess that up. I hardly consider flu shots to be one of our "talents."

Finally, how exactly are we just giving these flu shots away. We make $15-$20 profit on each shot. That's good for the profession. It actually is smart business to do more flu shots because they are great for your gross margin. In addition, I do get paid to give them. I make nearly $60/hour to be a pharmacist. That salary encompasses all of my professional responsibilities. I'm not a mercenary. I don't get paid per task I perform. My company pays me that because I am a pharmacist and capable of performing the duties of being a pharmacist.

Quite honestly, flu shots are one of most worthwhile things that I do. I am preventing disease. My flu shots might prevent people from being hospitalized with the flu, and in that way, it saves the health care system a lot of money. I don't see how this is a bad thing.

Of all the useless things we do in the pharmacy (dispensing Zpaks for colds, codeine products for cough, free antibiotics, etc.), there's no way I'm going to "stand up" and refuse to do something that actually is beneficial to both our business and our customers' health simply because I don't get paid more to do it. I get paid enough already.

Pharmacist's salaries are not one of the problems with the profession.

Thursday, September 23, 2010

More Shit That Doesn't Make Sense

Everyone knows where I stand on the health care debate in this country, so I won't repeat my reasoning and the facts that back up my reasoning. This blog post will not take a side in the health care discussion. It will simply point out a GIGANTIC logical flaw in the reasoning I often hear used to argue against universal health care.

"Health care is not a right. The Constitution doesn't have any mention of providing health care for the citizens of the United State."

These people are absolutely right. The Constitution makes no mention of health care. Want to know why? Because there practically was no health care in 1776!!

Penicillin wasn't even discovered until 1928. Surgery was rudimentary at best. Blood-letting was an accepted treatment for disease. Pretty much at the time the Constitution was written, a minor infection could, and often did, lead to death.

Perhaps if Thomas Jefferson lived in a time that had antibiotics, laparoscopic surgery, chemo and radiation therapy, X-Rays, MRIs, EKG's, blood work, and other common tools of modern health care practitioners, he would have made some mention about health care in that original Constitution and Bill of Rights.

Of course given the time period, he didn't, so we'll never truly know. Regardless, using the Constitution as argument against making health care a right to every citizen makes no sense at all. Hell, the original Constitution makes no mention of ending slavery either, but nearly 100 years later we managed to realize that perhaps our founding fathers had made an error on that issue.

Again, I'm not endorsing one side or the other in this post. I'm just pointing out some really stupid reasoning.

Tuesday, September 21, 2010

Something I Love About My Job

This is the first year that I've been able to give them, but now that I can, I have to say that I love giving flu shots. I'm finding that I actually look forward to going into work every day because of the chance that I can give some flu shots that day. In the past, I would dread the days I had to work. Flu shots have re-energized my enthusiasm for pharmacy.

Maybe it's a little stupid. I guess it's really not that big of a deal. Medical assistants can give flu shots. They don't jump up and down for joy every time they get to stick a needle in someone's arm. Despite this, I can't help but like doing it. For one, it's something different. Different is good.

Retail pharmacy, despite all the craziness, is a repetitive job. Every day is exactly the same. You fill prescriptions. You check prescriptions. You answer mostly the same questions all the time. You deal with the same insurance problems all the time. The days just seem to blend into each other because day after day after day you're doing the same damn thing.

Flu shots at least break up that repetitiveness. It gives me a momentary break from the prescription mill. I have a table set up in front of the pharmacy. I go out and talk to the patient for a minute or so. It's not really private, but it almost feels like I get a little bit of one on one time with every patient to whom I give a flu shot.

The best part is that my employer can't complain about me halting the regular prescription mill in order to give a shot. We make $15 to $20 profit on each shot. They're great for business. That's why pharmacies push these flu shots like crazy. They put signs and banners all over the place. They record messages on the store's automated system. They hold clinics, schedule appointments, and accept walk-ins. Flu shots are a gold mine.

What's great is that they're a gold mine we don't have to feel bad about pushing to our patients. Let's face it, most of the prescriptions we fill are completely unnecessary. How many Zpaks do we dispense for people who have the common cold? How many Robitussin with Codeine prescriptions do we dispense even though there's no strong evidence that codeine-related cough suppressants actually reduce cough? We dispense weight loss drugs to people that don't want to exercise. We dispense Vicodin to seemingly any patient that goes to the ER for anything.

Even the drugs that have some value mostly just treat chronic illnesses. There's not a whole lot of drugs that cure disease. We just treat them. We can't cure diabetes, so we give people insulin. Thanks to the modern diet, we can't prevent heart disease, so we load people up on statins and blood pressure medications.

Flu shots are different though. They PREVENT the flu. When I give a person a flu shot, I know that I have prevented that person from getting those particular strands of influenza for that season. For example, everyone I give a flu shot to this season will not get H1N1. 30,000 people die of influenza every year in this country. Getting people immunized would drastically reduce that number. In that way, flu shots are saving lives. I know that has nothing to do with why my employer wants me to give them. I know my employer just wants the money from them. However, no matter what the reasoning is, the more people that get flu shots, the better for public health.

Finally, flu shots have separated me from the other pharmacists I work with. My store has 3 pharmacists. The other 2 want nothing to do with injections. Both of them actually say they're afraid of needles. They don't want to even watch me give an injection. That's how opposed to giving flu shots they are.

That's fine with me. If they want to stay behind the times and limit their own scope of pharmacy practice, I'm not going to convince them otherwise. Right now, my competitive edge in my company is that I can immunize. I've given out 20 flu shots so far this season. I only started a little over a week ago. I know that's not a lot. I know a lot of other chains hold clinics and do other things that allow them to give dozens per day. My chain is behind the other pharmacies in its flu shot promotion. Even still, those 20 shots netted the store $300 in profit. That's $300 that no other pharmacist in our store could have generated. It's early in the season, so I'm sure I'm going to give out a whole lot more than that. Whatever that final number ends up being, the profits that go along with it are entirely because of me. I'd say that gives me a nice competitive edge.

In addition, our patients look at me different. I know that sounds corny and cliche, but they really do. I didn't think it would happen either, but it's true. They all ask questions, not just about the shot, but about other health issues they might have. They ask for information about other vaccines, and whatever else might come into their minds.

The best thing is giving the shot and hearing the patient say he didn't feel a thing. They see the professional way I carry myself, and the painless shot reinforces the idea that I'm someone that knows what I'm doing. They ask how long I've been giving out flu shots. Some have even ask who I work for because they're so used to going in and out of the pharmacy without ever interacting with a pharmacist that they never noticed I've been working in the store for over 4 years. Some comment, "they got you doing everything back there," and that makes me chuckle a little bit.

Flu shots are one of the few things I do in the pharmacy that I think are worthwhile. There's no downside to them. They're good for the store financially and in crafting a positive image. They're also good for public health. I don't feel bad advising and/or convincing someone to get a flu shot, which is more than I can say about almost every other product we sell.

It Goes With the Ongoing Discussion

There's a nice discussion going on in the comment section of the previous blog post. I thought this fits quite well with it.

Leave it to George Carlin to rain the truth down in the best possible way.

Sunday, September 19, 2010

My Generation and Younger is Screwed

Forgetting all the doom and gloom regarding dwindling oil supplies and climate change, this country has an enormous problem on the horizon, and it's mostly affecting my age group and younger.

How many people my age or younger will ever pay off a house? Most of my friends, despite working 50 to 60 hours per week, can't even afford to live by themselves. How will they ever afford a home? Even if they did some how scrape together enough money to pay a mortgage, how will they have families? How will they support children? How will they put those children through college?

Back 50 or 60 years ago, if you had a job, any job just about, you were OK. It didn't matter what you did. If you worked on an assembly line somewhere, chances are you made enough money to buy a home and pay the mortgage. You could put food on the table and pay the bills. You could raise kids. Your wife could work if she wanted, but you could get by without her income. You would have very little debt, and when you retired, chances are you'd be able to live off a company pension plan.

Back then, being employed meant being able to live. You might not be rich. You might not have the fanciest car or the best furniture, but you'd have a home. You wouldn't starve.

Fast forward to today...

I have a friend who is a manager at a restaurant chain. By all accounts, he does a pretty good job, and he's really energetic and enthusiastic about it, probably more than the job deserves. He makes less than $40,000 per year in a part of the country where the average home price is upwards of $250,000. He's tried to move out of his parents' house 3 times now. Each time, he only made it 4 or 5 months before running out of money. The last time, he rented an apartment with a roommate, and even with the roommates' contribution to the rent and bills, he couldn't afford to stay in the apartment.

Therefore, it was back to his parents' house for him. He's 28 years old, a manager, and he can't afford to live on his own. The kicker is that it could be even worse. He doesn't have any college loan debt because he went into the NAVY after high school. A lot of people my age are in the exact same position as him, except they also have over $60,000 in student loans.

When you start crunching the numbers, it doesn't seem possible that these people will ever get out of debt. They'll go to their graves owing money all over the place, or they'll file for bankruptcy, which of course doesn't eliminate the student loan debt.

This is the outlook for my generation though, and it's not pretty. I'm fortunate enough right now to have a job that makes well over $100,000 per year. That sounds like a lot, but even with my salary, and even just by myself, I can't have as comfortable a life as my parents did, and they were raising 2 kids! When I was growing up, we went on vacations just about every year. We had nice things. I pretty much had everything I could ever ask for. I can't afford the things my parents were able to afford for me, and I make more compared to my peers than they ever did.

My girlfriend has a job in a city. She has a 4-year college degree, and she makes just over $30,000 per year working in that city. As I wrote about before, she's trying to find an apartment in or near the city she works, but it's nearly impossible for her. She can't afford anything. She really wants to live without a roommate, but any decent apartment is well out of her price range. She has student loans and a car payment, so the only apartments she can really afford are 400 square foot efficiencies with long outdated appliances.

In order to find a decent apartment that she could afford, she'd have to look 40 or 50 miles outside of the city. How messed up is that? She works in the city, but she gets paid so little that she has to move 50 miles away in order to keep her job.

It's getting increasingly difficult for anyone my age or younger to live on their own. We're encouraged to go to college because "education is the key to our future success," or so we're told. However, most of us come out with huge student loan debt and degrees that get us jobs that pay a starting salary barely above minimum wage. It's no wonder people my age seem to me maturing more slowly, moving out on their own and starting families later than the previous generations. We simply cannot afford it. It takes a $100,000+ annual income to be able to do the things that the average American citizen of previous generations did.

It was a huge talking point during the previous Presidential election, and it drew a lot of ire from everyone on the right and a lot of people on the left. However, Barack Obama was 100% correct when he asserted that he have to redistribute the wealth in this country. It IS a problem! This isn't imaginary. It's not something crazy liberals are making up.

As of 2001, the top 1% of the wealthiest Americans owned 38% of the wealth in the country. The bottom 40% owned less than 1% of the nation's wealth.

Think about that for a second. Even though we hadn't quite reached 300 million citizens in 2001, we were pretty close, so lets use that as our nice round number. The top 3 million Americans OWNED 38 TIMES MORE WEALTH than the bottom 120 million Americans.

Again... 3 million people owned 38 times more wealth than 120 million people, and most sources say the disparity has only grown larger since 2001.

The top of society has everything, and the average American is working harder and harder to just get by. How is that right? How is that just?

From 1932 to 1981, the lowest tax rate for the top tax bracket was never below 63%. For most of the 1950's, the golden years of The United States, the top tax rate was over 90%. Despite this, the rich still managed to do just fine, but more importantly, the average American was far better off than he is today.

I don't know if taxing the richest Americans more is necessarily the ultimate solution. I don't think it's a bad thing though. The government has to work to help the people. That's it's role. It doesn't serve Wall Street. It doesn't cater to the top 1% of society. It's supposed to represent the masses and the collective good of the people.

All I know is that if the current trend continues, the economy will completely collapse because the other 297 million Americans won't be able to afford to own anything. When the majority of Americans work 50 to 60 hour work weeks and still struggle to make ends meet, it's definitely a sign that something is wrong.

Friday, September 17, 2010

We Don't Realize How Much We Know

We forget sometimes that even a pharmacist with a below average knowledge-base knows much more than the average person. Concepts that seem so simple and easily understood to us can be very difficult for the average patient to comprehend.

How many times do we roll our eyes when a customer comes to us with a box of Tylenol and asks, "my doctor said to get Tylenol. Is this the right one?" We're thinking that it says Tylenol right on the box. What a stupid question. It doesn't take a pharmacy degree to read.

Have you ever wandered out into the aisle and just marveled at the variety of Tylenol Brand products there are (well, there were at least, considering Tylenol is still in short supply from the recall)? There's Tylenol Cold, Tylenol Arthritis, Tylenol PM, Regular Strenght Tylenol, Extra Strength Tylenol, Children's Tylenol Liquid, Infant Tylenol Drops, Tylenol Severe Congestion, Tylenol 8 Hour, Tylenol Rapid Release Gels, Tylenol Allergy, etc., etc.

If I didn't know a thing about medication (and why would I if I wasn't in a medical profession?), I'd be completely lost. The doctor just said Tylenol. He didn't say there were so many different options. Is Extra Strength OK? How do I choose?

It's simple to us. We know that Tylenol is acetaminophen. We know that you can take 2 Extra Strength Tablets up to 4 times per day without exceeding the maximum allowable daily dose of 4 grams. We know that store brand acetaminophen works just as well as Tylenol, so we can save money. Hell, we even know that weight based dosing of Tylenol is 10 to 15 mg/kg per dose, so we can tell someone the correct dose for an infant even though it doesn't say it on the box.

That information is right at the front of our brains because it's one of the first things we learn when studying to become pharmacists, and we use it often. However, it's kind of complicated for a regular person, and that's only one drug! We can tell people just about everything about other common OTC active ingredients such as ibuprofen, naproxen, pseudoephedrine, phenylephrine, dextromethorphan, guaifenesin, diphenhydramine, doxylamine, chlorpheniramine, meclizine, dimenhydrinate, ceterizine, loratadine, famotodine, ranitidine, omeprazole, lansoprazole, cimetidine, simethicone, clotrimazole, terbinafine, salicylic acid, and on and on and on...

I just rattled off 22 ingredients off the top of my head (23 if you count acetaminophen). I can tell you the drug class of each of them, indications, common dosing, side effects, and important drug interactions. Again... That's simple stuff. Every pharmacist can do this. The average person doesn't have a chance in the world of knowing all that stuff.

Then we move behind the counter, and we have ACE Inhibitors, ARBs, HMG Co-A Reductase Inhbitors, sulfonyureas, the different types of insulins, Calcium Channel Blockers (dihydropyridine and non-dihydropyridine varieties), bisposphonates, proton pump inhibitors, all the varieties of beta blockers, corticosteroids, diuretics, and so many more classes. We know multiple drugs in each category, and we know a lot about them.

The amount of information is staggering, especially when you really get down to the nitty gritty. For example, not only do I know that simvastatin is an HMG Co-A reductase inhibitor, I also know that it's one of the more lipophilic ones, and has a higher risk of muscle related side effects (myalgias, myopathy, and extremely rarely rhabdomyolysis) than less lipophilic statins like atorvastatin. It's extensively metabolized by cytochrome P450 3A4, and thus, a lot of clinically significant interactions can be seen when used in combination with 3A4 inhibitors such as verapamil, diltiazem, clarithromycin, amiodarone, and even grapefruit juice. Because of this interaction, it's listed as a contraindication in the package insert to use doses over 20 mg in patients concurrently taking verapamil. I know that simvastatin is available in 5, 10, 20, 40, and 80 mg dosages. And again... I know all this information off the top of my head, and so do most pharmacists.

That's one drug. I can do this with dozens, maybe even hundreds of drugs. It's amazing when you actually stop and think about it.

The point of all this is that perhaps the next time a customer comes to the counter and asks what you immediately think is a stupid question, just remember how much more drug information you know and understand than he does. Maybe cut him a little slack. He's not supposed to know this stuff, whereas you get paid to know it.

In addition, be proud that you have accumulated this massive drug information database inside your brain, and don't ever be afraid to use what you know to help other people. Whether you like the title or not, you are a drug expert. No other professional in the world knows more about a wider variety of drugs than a pharmacist, and this information is incredibly useful even when you're away from the pharmacy. Pharmacists never stop being pharmacists just like doctors never stop being doctors. Being a pharmacist is more than just counting pills, even though that may be what you do the majority of the time you're at work. If someone asks you a drug related question when you're away from the pharmacy, be happy to answer them. It really won't take that long, and the person will greatly appreciate it. If you are able to help the person, it will put pharmacists and our abilities in a good light.

You want to save the profession? Start by helping the people around you. Slowly but surely, the word will spread that these pharmacists are full of information and important to society. Let's face it, pharmacists alone appealing to their corporate masters are not going to change anything. However, if not only pharmacists but the people start demanding better care from their pharmacists, that will have an effect. If we want to play by the rules of capitalism, then we have to make the market decide that pharmacists are valuable.

This was a strangely upbeat post from me. I gave myself a flu shot yesterday. Maybe delusions of grandeur is one of the side effects.

Thursday, September 16, 2010

Follow-up to My Previous Post

Isn't it amazing what divides people? You mention religion or politics and suddenly all sense of civility is gone, and people are at each other's throats. Good people. People who would otherwise really like each other and would get along swimmingly suddenly are fighting (sometimes violently) with each other over something so trivial.

Take this whole 9/11 "mosque" issue. You know... If there were no religions around, there would be no Islam. Without Islam, those muslim fundamentalists that crashed planes into the World Trade Center and Pentagon wouldn't be religious fundamentalists. They'd just be a bunch of crazy people who hate America, and everyone in the whole world would agree that those people are crazy, and that's all there would be to it.

Now, we have people blaming Islam for the actions of crazy people. We have an old tech at work. He's in his 60's. He fought in Vietnam. He likes to think he's as American as apple pie. He stated the other day that Muslims have no regard for human life and shouldn't be allowed to worship anywhere in this country. He said this despite the fact that we've had 3 Muslim employees who have worked for us within the last 2 years who were the nicest people you'll ever meet. Seriously, I can't think of nicer people than them, but our old "American" tech thinks all Muslims should be "round up and shot."

Religion divides more people than it unites, and it doesn't even make sense in doing so. For example, if you're a Christian, you believe in Jesus and the resurrection and all that stuff. Since you believe in that, do you believe Muslims are wrong? How about Jewish people? Are they wrong too? Is anyone who doesn't believe in your particular faith wrong?

I'm sure even if you believe they're wrong, any rational good-hearted Christian would say that it's OK. As long as they live a good and moral life, they'll still be accepted into the kingdom of Heaven. If that's the case, what's the point of any religion then? Why don't we just all agree that we should treat each other well and stop sectioning ourselves off into little groups who believe different things that ultimately don't matter?

As for prayer, I'm not saying the "power of prayer" has never helped anyone. Sugar pills have helped people too. Placebos actually work, that's why you have to compare drugs to placebo and not just to nothing at all. If people really believe something will help them, there's a good chance that it will.

Know what the crazy thing to think about is? A million years from now, humans, as we now know them, probably won't exist. The Earth will still be here. It will still be teeming with life, but the human race will be long gone. We'll have either evolved into another species or gone extinct from either a natural disaster or our own tendency towards violence. However, let's say by some incredibly long shot that humans actually do still exist a million years from now. I can assure you that your religion and all the other religions on this planet will no longer exist. The Earth will still be here though, and so will life in some form.

My point is that any religion or way of thought that somehow places a higher importance on human beings than any other animal or plant will be shown to be wrong when we no longer exist. Humans are no more important than a dog or a cat or a cockroach in the grand scheme of the universe. We're here now, but the span of human civilization will be nothing but a nanosecond compared to the entire span of the universe.

And that's the answer to what happens after we die... Life just keeps rolling along. It doesn't miss a beat. It just keeps going like we were never there. People don't like this explanation though. It makes them feel sad, lonely, and worthless. Therefore, they look for something that makes them feel like they matter. We don't matter... but that's OK. It really is. Life doesn't have to have a purpose. It can just exist, and that's perfectly fine.

- This post was originally an email to a friend regarding our differing views on religion. I thought it fit in nicely on the blog, so I copied it and made a few small alterations. Therefore, if it seems a little disjointed, it wasn't originally intended to be a blog post. I just like putting my ideas in my blog, especially if they are pretty well thought-out.

Tuesday, September 14, 2010

Shit That Doesn't Make Sense

I'm not going to make many friends with this post, but that's never my intention anyway, so oh well...

"Everything happens for a reason."

Is that not the most stupid, insane, bullshit statement ever? Everything happens for a reason? What kind of reason could there be for a 6-year old girl dying of Leukemia? Girl gets leukemia. The family's health insurance drags their feet over paying for anything to do with her care. Therefore, the family nearly goes bankrupt trying to pay for a treatment that might possibly save their child's life. However in the end, it doesn't work. The father withdraws into himself and becomes a workaholic because he doesn't know how else to deal with his little girl's death. The mother, who just lost her child, is now abandoned by her husband when she needs him most. She develops a drinking problem, and the entire family, once happy, spirals out of control until tragedy after tragedy falls upon them.

I completely made that situation up, but it could easily happen, and I'm sure it's happened thousands of times before. Again, what was the reason for that? And, if there was a reason, who decided what the reason is? God? Does God decide the fate of everyone? Is that what it means when people say "everything happens for a reason?" Do they mean it's part of God's plan?

What kind of asshole God would do that to a little girl and her family? I was raised a catholic. I went to catechism and did all that church stuff. I was taught that God loves us all. Yeah? Well, he sure has a fucked up way of showing it.

God loves us all... except for the people he just randomly decides to shit on for no apparent reason other than it fits into some cosmic plan in some indiscernible way. Then you get the bat shit fucking insane religious people that come along and say, "God loved that little girl so much that he brought her to the kingdom of Heaven early." Fuck these people. Seriously... When you have to start dipping into ridiculous reasoning like that, you need to just give up and admit that the whole ideas of everything happening for a reason, God's plan, and God loves us all is just bullshit.

Then there's prayer... Say that little girl's family was religious (and it doesn't even matter what religion). They undoubtedly prayed every day for a miracle to save their child. Every day they prayed and hoped and wished as hard as they could that God would hear them. Religious friends of the family offered their support and prayers. Hell, knowing today's world, all 400 of their Facebook friends probably chimed in saying they'll keep them in their prayers. Then the girl dies, and those same people who endlessly prayed for the girl turn around and say, "well, God had a special purpose for her in Heaven."

Well, that ties back into God's plan. If God had a special purpose for her, then why the fuck did you bother praying in the first place? You pretty much admitted that God does whatever he wants whenever he wants. If he has some sort of giant plan for the universe, why would he change it because a few people decided to pray? It's a contradiction.

Even if you don't believe that God has a plan for everything that ever happened and ever will happen, even if you don't believe in predestination, wouldn't you be pissed off that God didn't answer your prayers? Shit, if I had a 6-year old daughter dying of cancer, and I prayed to God for her life only to have God completely ignore me, I'd say fuck that all powerful deity. I would have been better off praying to her doctors. At least they tried to do something. God just sat around and let it happen.

Hunger, poverty, war, disease, natural disasters, United Health Care... All of these are signs that if there really is a God, he just doesn't give a shit about us. He doesn't love us. He doesn't care for us. If he exists, he just lets us be. He doesn't answer prayers. He doesn't perform miracles. He just sits back, maybe with a big bowl of popcorn, and watches us destroy ourselves and the planet. In God's eyes, the human race is nothing more than a multi-trillion dollar Roland Emmerich film.

Do you see why I have a problem with God and religion in general? When you start using logic, it makes no sense at all. That's not to say that I'm against the notion of spirituality. There are a lot of things that we'll never know and understand about this universe. I believe that there has to be some purpose for the existence of the universe. There has to be some way it came to be, and it only makes sense that a higher power (whether it be an intelligent power or some other form) must have created it. I just don't believe in the God that religions try to push on people. I don't believe in the hocus pocus aspects of them. I don't believe in God having a son, Jesus. I don't believe Mohammed was a prophet of any kind. I don't believe Moses spoke to a burning bush (unless he was high off his ass), and I certainly don't believe he waved his staff and parted the Red Sea. They're all fairy tales, just like every other thing that goes into these so-called Holy Books.

If you want to treat religion as a social club, that's fine. It can be just like those Star Trek conventions where people dress up like Spock and speak Klingon to each other. It's utterly meaningless, but those people enjoy it and find camaraderie in it, so it's fine and harmless. They really get into it, but none of them actually believe Captain Kirk, Spock, and the Starship Enterprise really existed. That's the way religion should be. People can get together and talk about their favorite episodes from the Bible, perhaps the one where Jesus healed the cripples, and then go home to their normal lives.

Like I said at the beginning, I'm sure I won't make friends with this post, but this is how I really feel about this stuff, so it's about time it made an appearance on my blog. I plan to write more entries about stuff that doesn't make sense in the future.

Tuesday, August 31, 2010

Sick Time

This is a question to the audience: What is your employer's policy on sick time?

I only ask because I can't figure out if my company even has a policy. Any member of our regular non-pharmacist staff gets 5 paid sick days per year. However, there seems to be no limit to the number of times a person can call out sick to work without being penalized other than not getting paid.

We have 2 technicians who both have been absent for work over 15 times this year so far. It's always one thing or another with one of them. First it was a back problem, which somehow evolved into a knee problem. Then there was a bout of Raynaud's Syndrome that mysteriously vanished within a couple of weeks. Then she suddenly developed slightly elevated blood pressure which somehow forced her to miss a day. There were a number of migraines, sinus infections, cases of bronchitis, and other general illnesses. Now, it's a stomach problem that's caused her to get an endoscopy. The list of problems just never ends.

I just got done with a shitty day of work because on top of her calling out sick, we had another tech who had to have surgery and is missing 3 weeks of work. In addition, another one of our clerks was on vacation. We don't have the hours or the staff members to replace anyone, so we worked short 3 people on a busy weekday when we get our big store order.

Even if we accept the notion that all her sick days were legitimate, doesn't there come a point where we just say that she's hindering the pharmacy staff with her constant absenteeism, and we threaten to suspend her if she misses any more days? Does it work like this in other companies?

I complained about this to one of my friends who is a manager for a non-pharmacy company. He said that his employees get 5 sick days every 365 days. If they go over that, they either can take a medical leave of absence for an ongoing medical issue, or they get suspended and possibly fired.

I just don't know what can be done. If the ailments are real, then how do you tell a person to stop getting sick? However, if the ailments are real, I also wonder just how in the world does she get sick so often? Why does she get so sick she has to miss work twice a month, but I never get sick enough to call out of work?

I said it before, and I'll say it again: I don't understand being sick. I really don't. I almost never get sick. I get a headache every once in a while. Maybe twice a year I get a minor sinus cold and a sore throat, but that's it. Meanwhile, we have people who come down with one illness after another all year long. Do their immune systems suck that badly or is mine just that good?

I'm just so frustrated with never having a full staff. We can never catch a break. On a slow day, we get 2 or 3 call outs, and we end up going crazy trying to do a volume that should be easy. If we don't get any call outs, we get slammed volume-wise. I would just love for a nice smooth day every once in a while.

I guess I shouldn't expect that though. This is retail pharmacy after all.

Monday, August 30, 2010

We Should Not Be Sending the Message that It's OK to Be Fat

Obesity is the single biggest health problem in the United States. We spend billions of health care dollars each year on these diseases associated with obesity. However, for whatever reason, we're not taught to treat obesity with the same disdain as smoking.

Smoking is a nasty habit. It makes you look bad. It makes you smell bad. It greatly increases your risk for cancer and heart disease. In addition, second hand smoke can pose a health risk to people who do not smoke. More and more people in this country seem to be in agreement that smoking is a horrible thing, and we should do whatever we can to curb the use of cigarettes.

Now, let's look at obesity...

It's a nasty condition. It makes you considerably less attractive. Obese people tend to sweat a lot at the slightest exertion and thus emanate an unpleasant body odor. Obesity is the probably the greatest risk factor for heart disease and Type II Diabetes. In addition, the notion that one person's obesity isn't something that can affect the health of another person isn't quite correct. If you are in a relationship, if one person gains weight, the other person is also likely to gain weight. In a group of friends, if one friend gains weight, the other friends tend to put on some pounds too.

Obesity and unhealthy eating is probably even more addicting than smoking, but we just don't think of it the same way. Consider this: If someone at your work brings in cupcakes, and everyone else is eating them, you're probably going to eat those cupcakes too. If the people around you always have unhealthy food, you're also much more likely to eat unhealthy.

I can vouch for this stuff first hand. I was never obese or even close to obese, but I used to eat quite unhealthy. My coworkers used to order out for lunch a lot, and that would mean 3 or 4 times a week I was eating french fries, fried sandwiches, milkshakes, etc. Eating this way was the culture of the pharmacy, so everyone participated, and you know what? We all gained weight.

After finally realizing that I valued being healthy and in-shape, I cleaned up my diet quite a bit. I started bringing lunch to work, so whenever someone wanted to order out, I never got anything because I brought my lunch. Seeing me eat lean chicken breast sandwiches on whole wheat every day, and watching me drop 13 pounds while getting into the best shape of my life had an effect on my coworkers. Suddenly, they started bringing their lunches more often. We stopped ordering out. Everyone started losing weight and exercising more, and we all became healthier for it.

As it stands, obesity is part of the culture of the United States. Burgers, fried food, fast food restaurants, ice cream sundaes, cookies, cakes, and brownies. We all view these things as the finer treats in life. Our lives are centered around unhealthy food. It's just a part of our lives now, and we actually think it's unusual when someone tries to eat healthy.

I've actually been ridiculed for my attempts to eat healthy. Does that make any sense? "Why are you going on a diet and doing all this exercise? You don't need to lose weight," many people said. Upon telling a coworker I lost over 10 pounds, she actually told me that I'm supposed to fill out as I get older instead of getting smaller.

Those are just a couple examples of the fucked up way of thinking people have in this country. We're so used to people being overweight, that we think it's highly abnormal for someone to be healthy and fit. Instead of ridiculing the 250 lb guy with his gut hanging well out over his pants for eating that tub of ice cream, we poke fun at the 155 lb guy who refuses the ice cream because he wants to be able to run a sub-6 minute mile well into his thirties. Where's the sense in this?

Why do we tax cigarettes to the point where they cost almost $10 per pack, but unhealthy fast food is usually some of the cheapest food you can find? Those McDonald's cheeseburgers and Oreo Cookies are just as likely to cut your life short as cigarettes, but nobody acts disgusted when you break out a bag of Oreos. You have to be 18 to smoke cigarettes, but you can start cramming donuts down your throat the moment you're old enough to chew.

I can hear the dissenting voices now... "Some junk food every once in a while isn't that bad. It's all about moderation." Of course, my response is that the occasional cigarette isn't that bad either as long as you can keep it on an occasional basis.

"But cigarettes have nicotine, and nicotine is physically addictive!"

Sugar and high fat food is just as physically addicting as cigarettes. In fact, it's probably more addicting. You don't think so? I challenge you to stop eating candy, sweets, and junk food for as long as you can. How long do you think you'll last? A day? Maybe 2 before you break down and have that little piece of chocolate. You'll go through withdrawals, but a different kind than if you tried to quit smoking. You'll have that insatiable craving for something sweet or salty. The craving will be so strong that it messes with your mind. Every time you think of food, you'll crave pizza or a chocolate bar or buffalo wings. You'll have a perfectly edible healthy meal in front of you, but it will taste terrible to you because it doesn't have those bad ingredients you crave. If you stop and think here, you'll realize that you're addicted to that unhealthy food. It's no less of an addiction than smokers to their cigarettes. It's just far more socially acceptable for some reason.

Back to my main premise... Obesity is something that should be looked down upon as much as smoking. We shouldn't be passing along the notion that it's OK to be overweight. We certainly shouldn't be telling people to feel proud and unashamed of their bodies when they're 50+ pounds overweight. Being significantly overweight is literally the worst thing you can do to your body. Fat people take up a far bigger chunk of health care dollars than any other group, and in just about every case, obesity is preventable.

Therefore, I would like to lend my support to any bill or proposed law that would tax the shit out of unhealthy food. People do not have the willpower or the knowledge to stop eating so poorly on their own, and this country does not have a culture that supports a healthy lifestyle. If it takes the government to step in and mandate healthy eating in order to get the incredible number of obese Americans to eat right, get to the gym, and drop a few pants sizes, then that's what we should do. The government's anti-smoking agenda completely changed the nation's view on smoking. I'm sure it could do the same for obesity.

Monday, August 9, 2010

Eisai and Pfizer Are the Latest to Honor Former NBA Great Michael Jordan

With the approval of Eisai and Pfizer's new drug application for Aricept 23 mg, the companies are the latest on a long list of companies and individuals to pay homage to NBA legend Michael Jordan.

"Michael Jordan's awe-inspiring play, competitive spirit, and overwhelming charisma has left a lasting impression on the minds and hearts of billions of people world wide," stated Pfizer CEO, Jeffrey Kindler. In helping to maintain and improve the cognitive abilities of those suffering from Alzheimer's Disease, we hope Aricept can keep the memories of MJ's amazing athletic feats alive for years to come."

Kindler continued, "We could have made this high dose Aricept formulation be 20 mg, or even 25 mg in order to be consistent with the 5 mg increment dosing of Aricept that is already in place. However, we thought that this was the perfect time and Aricept was the right drug to honor the great Michael Jordan. Thus, we settled on 23 mg."

***(This story is obviously not true... at least not to my knowledge. Eisai and Pfizer very well could have been honoring Jordan. How else did they come up with a nice, round number like 23 mg? Was 20 mg way too low? Was 25 just too high? We'll never know.)***

Friday, August 6, 2010

The Future of Retail Pharmacy

$4 Generics

Free Antibiotics

Free Diabetes Medication


All across the pharmacy blogosphere, pharmacists and technicians have complained that these developments in retail pharmacy are steps on the road to the end of the profession as we know it. Pharmacists are being devalued by giving away product and professional services for free, and it seems like there's nothing we can do to stand in the way of our corporate masters instilling these plans.

I'm going to just lay it out there as I see it, and you can agree, disagree, discuss it, whatever. The retail pharmacist is on the way out. I don't know how much longer it will be before it happens, but I truly feel that it will eventually happen and probably within my working lifetime.

Let's just take a step back and look at how retail pharmacy started.

Back in the day, retail pharmacists possessed one special skill that no other professional had. Pharmacists could compound medication. A physician would write a prescription for a specific ointment, solution, or other dosage form that needed to be specially prepared before dispensing to a patient. Pharmacists filled that role. They were needed. No one else had the training to make complicated compounds. It was all up to the pharmacist.

As the years passed, drug manufacturers started to make their own pre-packaged dosage forms. Slowly, the need for specialized dosage forms for patients decreased as most patients could be treated using the manufactured products. Compounding started to go away, but the convention of a retail pharmacist remained. Doctors still wrote prescriptions, and pharmacists still filled those prescriptions. However, instead of using their specialized skills, they simply pulled a product off the shelf and stuck a label on it.

To make themselves feel more useful and professional, the notion of counseling on medication came along. Pharmacists felt they really should be doing more than sticking a label on a bottle, so they decided that their new professional role would be medication counseling. However, medication counseling isn't something that is unique to the profession of pharmacy. Doctors can counsel patients on medications. So can APRNs, physicians assistants, nurses, and pretty much any health care professional. You might be able to make an argument that a pharmacist undergoes more intensive schooling about drugs than any other health care professional, and therefore, they are best fitted to provide counseling. Regardless, unlike compounding, counseling is not a skill unique to pharmacists.

It shows too. Feel free to disagree with me, but from my perspective, I do not think that most retail pharmacists are presently capable of providing medication counseling to patients above and beyond any other health care provider. Some retail pharmacists take an active role in learning as much as they can about medications out of either curiosity or a feeling of professional obligation. Most others are just happy to count by five all day, and for the most part, their employers will let them. I think reading pharmacy blogs gives us a skewed perspective of the sense of professional responsibility and enthusiasm that most pharmacists have.

In my experience, most just want a paycheck. They got into pharmacy because they liked the idea of getting paid big bucks to count out pills all day. I'll admit that's the reason I went to pharmacy school. It looked like a really easy job that didn't have a whole lot of responsibilities except to not kill someone. Obviously, I wasn't quite correct, but my point stands. Most retail pharmacists do not choose the profession for the same reason that people choose to become doctors or nurses. Most retail pharmacists didn't choose retail pharmacy because they thought they were providing health care. They chose it because it was a science profession that got paid well and was on the outskirts of health care without actually being health care.

Again, I'm generalizing. This isn't why ALL retail pharmacists chose the profession, but in my experience, it really seems to be why the majority did.

Most pharmacists would rather not counsel. Now, if a law came out and forced pharmacists to counsel, I'm sure most of them would do so out of fear of losing their jobs. However, I think most pharmacists are just hoping that every customer that comes to pick up medication checks that little counseling denied box.

Since retail pharmacy is run by giant corporations like CVS, Walgreens, and Walmart, you can bet that unless there's some money involved in counseling, no corporation will truly start an initiative to promote counseling on all medications. Since giant corporations rule health insurance in this country, you can bet that they'll do very little to help pharmacies get reimbursed for standard counseling on all prescriptions. Unless some kind of law gets passed that absolutely demands counseling on all new prescriptions (and that law will be fought tooth and nail by the big corporations), you won't see big chain pharmacies really forcing their pharmacists to counsel. They'll pay lip service to the public, but their corporate policies will actually discourage services that don't provide monetary benefit.

If pharmacists are not compounding, and they're not really counseling, what purpose do we really have? Why do we get paid so much when essentially all we get paid for is to fill prescriptions? The answer is that we don't have a true purpose in the current pharmacy model. We're superfluous, unnecessary. Our 6 figure salaries are the biggest thing standing in the way of those giant corporations making more money. Since we no longer offer a service no other health care professional can provide, we can be phased out in favor of less expensive labor in the form of trained pharmacy technicians and increased use of robotics.

Is the elimination of the retail pharmacist the best thing for the public? Absolutely not. Mistakes will increase, and even if we are not using our clinical knowledge all that much, the fact that anyone who has gone through as much difficult schooling as a pharmacist has to have a certain degree of intelligence and responsibility that would serve well in any job. However, what's in the best interests of big corporations is rarely what's in the best interest of the general public. The corporations will try to make more money in any way they can, and customers will adjust to whatever future changes are made to the current retail pharmacy format. For all the talk about how the United States is the land of the free, the vast majority of the general public seems to simply adjust and accept whatever choices are taken away from them. If the corporations change and offer no other choice, the American people will go along for the ride. They might complain a little. They might say they liked things better the old way, but in the end, they'll just roll with the punches. Therefore, don't expect the public to put up much of a fight if retail pharmacists are greatly reduced or eliminated altogether.

I feel like I'm in a race against time. I truly think the days of the retail pharmacist as we know them are numbered. However, I don't know how much more time we have. Therefore, I'm hoping that my job will last just long enough for me to figure out what else I can do with my life that would provide some kind of service or benefit to the general public. I'll admit that if I thought the job would last forever, even as much as I don't believe in what I'm doing, I'd probably continue doing it simply because it pays well enough for me to live a nice, comfortable life. I don't think it will last forever though. I'm not even sure if it'll last another 5 years (for a variety of factors not just corporate elimination of pharmacists). There has to be something else I can offer that few others can. I think that's the secret to job security.

Tuesday, August 3, 2010

Friendly and Helpful

"This is a medication I can't be without. Can you give me some medication until my doctor calls it in?"

This was uttered by a man who had called in a refill for his Effexor XR late on a Friday afternoon only to realize he had no refills left. He was all out of his medication that he "can't be without."

"Yes, of course we can give you some to get through the weekend, and we'll call the office for you on Monday to get the refill authorization." That's what I politely told him. I work for a corporation, and that's what I have to say to people.

However, I really wanted to have a conversation with this man. "You need it? Oh yeah... What would happen if you don't get it?" I really wanted to inquire. If he missed one weekend of Effexor XR, would he die? Would he get very depressed? Would he get really sick? I really wanted to know. If he needs it, does that mean he'll be taking Effexor XR for the rest of his life? What happens if the company decided to stop making Effexor XR one day? That would force him to use the generic, and every crazy person knows that those generics just aren't as good as the brands. What would he do? I guess he'd just cease to exist.

Moreover, if he "can't go without it," then why didn't he call it in really early? If he "can't go without it," why wasn't he on top of how many refills he had left? Why didn't he call the doctor's office directly instead of just leaving it up to us? If I couldn't go without something, I would do whatever I had to do to make sure I didn't run out of it. It would probably get my undivided attention.

Alas, I can't say these things. I have to remain friendly and helpful or risk losing a customer.

"This IS my correct insurance card. It's the only card I ever used at any pharmacy. They never sent me a new one, and nothing should have changed. Can you call the insurance company to find out what's the problem?" This was in response to a filled after coverage terminated rejection. She stood at the counter glaring at us making no indication she would move from that spot until someone called the insurance company. So I fucking called them and acted happy to do so.

I would have really loved to make a wager with her though. "I bet you the cash price of this prescription that you have a different insurance card." How do you think she would have handled that one? I think I wouldn't have a job today if I proposed that bet to her. My district manager would have fired me on the spot probably.

I was right though. I usually am in these situations, especially dealing with customers who don't know what the fuck they're doing. I've recently been called arrogant because I stated that I'm smarter than most people. You want to know what arrogance really is though? Arrogance is a customer coming into my pharmacy and basically telling me that I don't know how to do my job. I told that woman that her old insurance coverage is expired and that we needed to see her new card. She told me I was wrong. Is that not the ultimate form of arrogance for someone who hasn't got a clue to argue with someone who, for all intents and purposes, is an expert?

I wasted of 5 to 10 minutes of my time, and what did I get out of it? Nothing. She ultimately didn't take her prescription because her insurance didn't work.

I get paid roughly a dollar per minute. Therefore, I propose that in situations like this I should be able to get out a little timer and inform the patient that I will make the call to the insurance company for her. However, if I'm right, she will have to pay me one dollar for every minute I waste confirming something I already knew to be true.

It makes perfect sense, but it could never happen because god forbid we just might piss off a customer. Instead, I waste time and money doing pointless shit all day while smiling and acting friendly. I have to wait until I get home to say "FUCK YOU!"

Friday, July 30, 2010

Let's Stop Pretending There's Privacy in Retail Pharmacy

HIPAA, HIPAA, HIPAA, HIPAA... Everyone's pharmacy employer pounds those 5 letters into us all the time. We're all concerned with privacy. Every time there's a privacy leak in a health care facility (be it a hospital, pharmacy, whatever), we all go ape shit about it. "How could this happen?" "Why aren't they more careful?"

I'm going to let you in on something that's not really a secret: THERE IS NO PRIVACY IN RETAIL PHARMACY. Now, that that's out of the way, we can all stop pretending and get back to doing our jobs.

See, the problem is that people are only selectively concerned about privacy. For example, many times some customer will get all belligerent because we'll ask for his address when picking up a prescription. "I don't want to shout out to the world where I live!!" (Of course, he has no problem loudly broadcasting how much of an asshole he is). Not to stereotype, but there seem to be more women worried about this one than men. It seems the skittish ones are always worried about someone following them home and raping them or something. Who knows? Who cares?

The big one is that we can't say the name of the medications our customers are picking up. It's a HUGE no-no to tell the world that John Smith is picking up Viagra or that wholesome looking Jane Doe is getting Valtrex for the raging case of Herpes she picked up from one of her wild weekends. I completely understand the desire to keep information like this private. Some of this is embarrassing shit. Therefore, it makes sense that a person might be a little peeved if some of this information was intentionally or unintentionally made public.

However, people only seem to be worried about privacy when it conveniences them. They really don't want complete privacy at all times, just when privacy doesn't get in their way.

Want proof? Here's a very simple way to illustrate what I mean. Go get your phone, and call your pharmacy. Make sure to speak to a pharmacist because all calls regarding this kind of sensitive material should be handled by a highly trained professional. Once you have the pharmacist on the phone, ask if there are any prescriptions filled for yourself. Ask for the name of the medication, what it's used for, and the price. I guarantee you that the pharmacist answers all your questions in his most customer-friendly tone of voice.

Now, if you're being consistent about this whole privacy thing, you should stop the pharmacist mid sentence as he's explaining your medication to you, and loudly proclaim, "YOU'RE VIOLATING MY PRIVACY!!!!"

I work in a pharmacy that fills a little less than 2,000 scripts per week. We have a lot of customers. I can match a face to a name of maybe 15% of our customers. Out of that 15%, there are only a handful of them that I'm so familiar with that I can recognize their voices over the phone. Therefore, any time I give out any information over the phone to anyone whose voice I don't recognize, I'm violating HIPAA.

95% of the time I don't have the slightest idea who I'm talking to over the phone. Someone calls and asks a question. I answer it. Someone calls and wants to know if a prescription has been called in for so-and-so. I tell them. I'll even tell them what it is and what it's for. I'm sure this is true of any pharmacy.

Have you ever tried to tell someone you can't give out information over the phone? The person gets all pissy. They don't care about the privacy laws in that instance. They only care about privacy when being private doesn't stand in the way of getting information they want at a time that conveniences them.

Here's another question: What percentage of prescriptions are actually picked up by the person for whom the prescription is filled? 30-40%? Maybe? It's almost comical. Seriously, try to keep track of who picks up for who one day. Most of the time, the person picking up is the mother, father, husband, wife, girlfriend, boyfriend, son, daughter, relative, friend, etc. of the person for whom the prescription is filled. We have no clue who any of these people are. If Jane Doe comes to pick up Jane Smith's prescription, most of the time, unless told otherwise, we'll just assume that Jane Doe is Jane Smith. We'll even offer to counsel Jane Doe on Jane Smith's medications!!! What kind of privacy is that???

In most cases, anyone can walk up to any pharmacy and pick up anyone's prescription. We don't ask every customer for ID. Hell, we hardly ask anyone for ID. Just about the only time anyone whips out an ID at our pharmacy counter is when they're buying pseudoephedrine products. There's more discretion in buying fucking Sudafed than there is picking up a medication for someone. Once again... How is this privacy?

You know what though? We want it this way. How fucking inconvenient would it be to have to show an ID for every pharmacy transaction? It would be incredibly frustrating to have to cut through miles and miles of privacy red tape just to find out over the phone the copay on your prescription. Let's all face it: We don't really want true privacy at the pharmacy. We just want the illusion of privacy. We want there to be just enough privacy protocol and procedures followed to demonstrate to us that the pharmacy at least cares enough not to blurt out your medical history to the entire store. It makes us feel comfortable and maybe helps us sleep at night.

It's all just an illusion though. Therefore, let's stop with the HIPAA pretenses and get rid of all that stupid red tape so that we might be able to more easily do our jobs.

Friday, July 23, 2010

I Feel This Needs to be Said

There are parts I agree with in your blog and parts I do not agree with.

Let's start with opposing opinions and then I'll state was opinions I share with you.

First, let me give you some background information

- I am a 20 yr old female college student, in school full time and working roughly 25 hrs/week part-time at a retail pharmacy. (no school this summer so I'm working more hours but you get the picture). I have worked at this retail pharmacy for 10 months.

I don't get why you give so little respect to your technicians? How long have they been working for you? Also, it's good to have them ask you questions in my opinion. Would you rather them shut up, make a mistake, you not catch up, and serious repercussions arise from this incident or spending 10 seconds out of your hectic schedule to answer their question? Are these certified/senior techs or what? In that case I could understand some but otherwise no.

Another thing is your arrogance is seemingly obvious. Let me quote you

"Moreover, despite being much more intelligent and more educated than pretty much everyone in the entire store, I ultimately have to answer to and follow the asinine rules made up by "head cashiers." Once again, I went through 6 years of college to get a doctorate in pharmacy. I graduated in the top 10% of my class."

Are you serious, sir?

Yes... I am absolutely serious.

I'll get to the tech thing in a second, but let me start with the arrogance accusation.

I'm sick of this prevailing attitude where intelligent people are not allowed to say or act as if they are more intelligent than others. Note that more intelligent does not mean "better." It simply means more intelligent.

On a personal level, it's not arrogant to state that I'm more intelligent than most people I meet. In just about every single way you can measure intelligence, I've always ended up in the 90th to 95th percentile. My grades, my class ranking, my grade school standardized testing scores, the SATs, the NAPLEX, my IQ. In all of these things, I've consistently been in that top 5 to 10%. Now, I realize that using any one of them to measure intelligence is obviously flawed. However, when you take into consideration the combination of all those things, you just have to state, as a FACT, that I'm more intelligent than most people. I'm not the most intelligent. There are a lot of people who are a lot smarter than me. I'm not a genius in anything. I'm just pretty bright.

That doesn't mean I go around telling everyone I meet that I'm smarter than they are. People don't like it when you boast about how great you are all day. It's fucking annoying. However, I do walk through life with the thought that I'm probably smarter than 90% of the people I meet. You call it arrogance. I call it confidence based on a lifetime of testing and evaluation. It's one of the few things about myself I am very confident in. That doesn't mean I think I'm always right. That doesn't mean I'm unreceptive of other people's thoughts, opinions, or suggestions. All it means is that I trust myself to make good decisions, solve problems better, and know more things than most of the people around me. I have confidence that I can depend on myself to correctly evaluate situations and come to a logical conclusion.

Moreover, this is my blog, and I'm not at all worried about offending the delicate sensibilities of random people on the internet. I hate being politically correct and having to watch what I say in order to not offend anyone. However, I do it in real life because, quite frankly, it's too much of a hassle to argue with people all day over stupid shit. Not a problem on my blog. I don't have to work with any of my readers. I don't have to get along with any of my readers. I can write what's truly on my mind, and if people don't like it, they can tell me in a comment, and we can have a nice discussion about it. Or they can not read anymore. It doesn't bother me either way. I'm not doing this to make money. I write a blog because occasionally it helps to put ideas into writing. Plus, it keeps my mind and writing sharp.

In addition, I used myself as an example of an intelligent pharmacist, but I wasn't necessarily talking about just myself. In most cases, the pharmacist is going to be the most intelligent employee in the store. It's just a fact. Pharmacists go through 6 years of what everyone always says is rigorous college courses in order to be certified a drug expert. You have to be pretty intelligent just to get into pharmacy school. Then you have to be even more intelligent to make it to the end of pharmacy school. I'd like to think that someone who has survived that kind of weeding out process gets the benefit of the doubt on being smarter (or at the very least more knowledgeable) than a career cashier or merchandise manager.

As for the technicians...

There are a lot of really great technicians out there who really do a good job. Unfortunately as in pretty much every other profession, the good ones are far outnumbered by the poor and mediocre ones. The technicians in my store are mediocre at best. We have 4 certified pharmacy technicians (one is nationally certified). Out of the 4, only 2 can input a new prescription, and when they do, they make a mistake probably 40% of the time. We have a tech who has worked in the store for over 25 years, and she absolutely refuses to input new prescriptions because she's worried she'll make a mistake. She makes over $20/hr and spends the majority of her day at the register or going through our doctors' faxes. She has nothing to do with the filling process. Our nationally certified technician is such a ditz that I'm afraid to depend on her for anything. She's in her own world for most of the day... that's of course if you can get her to do anything other than text message and take bathroom breaks.

I want my staff to ask questions because I don't want them to screw something up by trying to do something they don't know how. I answer all these questions without showing frustration. I try to help them. However, I also expect them to catch on and improve over time. They don't. It's frustrating, and it creates one more thing I have to worry about during the course of the day. I have to watch and listen for any sign that they might be making a mistake, which takes my attention away from filling prescriptions accurately and counseling patients.

It's not just my pharmacy either. If you look around the pharmacy blogosphere, you'll see countless posts about dealing with lazy, inept technicians. In general, technicians aren't as smart as pharmacists. Secondly, they don't care as much as pharmacists. It's not their licenses on the line. A lot of technicians are working part time while going to school, so they don't think very much about calling out sick on a sunny day when they'd rather be at the beach than work. They don't have that same sense of responsibility as pharmacists, and it shows.

Let me reiterate that I'm not including all technicians. I know there are great ones out there. I've worked with great technicians before. They help so much that it's impossible to overstate how nice it is when you're lucky enough to have a great technician. Therefore, the last few paragraphs are not aimed at the great technicians reading this. They're aimed at their coworkers.

Agree with me. Disagree with me. Comment. Email me. Ignore me. Whatever. I'm game for a discussion if anyone really desires one.