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.