Writing to Keep My Mind Sharp

For the past couple of weeks, I've felt an urge to write. The only problem is that I can't think of suitable topics. Therefore, I've produced nothing. Basically, the intent of this post is to just write for a little bit to see if something worthwhile comes out of it.

I've always said that I used writing as not only a means of expression but also as a way to try to make sense of the jumbled thoughts in my mind. Writing also serves another purpose for me. I find it very intellectually stimulating.

A lot of my blog posts were about my feelings at certain times of my life. However, there were also many posts where I would give my opinions on a specific topic. These posts could be looked at almost like persuasive writing. I'd put out an assertion and then try to back it up using logic or evidence.

I find those kind of posts the most intellectually stimulating. As I'm writing them, I can literally feel different areas of my brain come to life. Working through the logic and creating my argument kind of feels like an adrenaline rush. It's a challenge, and even though I'm the one who made the particular assertion in the first place, I feel like I'm teaching myself about it. It's hard to explain.

It's also hard to get that kind of stimulation anywhere else. At work, I have to constantly defer to other people. Corporate makes a new policy, and I'm expected to carry it out. There's no room for argument, no room for disagreement. If corporate wants to give out free antibiotics, no amount of persuasive logic is going to change their minds.

With customers, I'm either the drug expert who dispenses medical advice, or I'm the customer service representative who has to basically kiss ass. There's not a whole lot of genuine back and forth. The customers don't challenge my knowledge, and I can't challenge them when I think they're being stupid.

My girlfriend and I hardly ever argue. I know; most people would consider that a good thing. And it is. Sometimes though, I feel like there's something missing if there's no arguing. I feel like neither of us are challenging each other. We certainly can't agree on everything, so if we're not arguing at least sometimes, then we really aren't being completely honest.

However when it comes to my blog, anyone reading is free to fire back at me. They can agree, disagree, or bring up another point that I never considered. I crave that back and forth. It keeps my mind moving. It keeps me from getting complacent. I need my beliefs to be challenged occasionally.

That's why I haven't quite given up this blog. I don't write very often anymore, but I like leaving open the option to write. I've thought about starting a new, non-anonymous blog, but then I have to come up with some kind of clear narrative. For example, I can't bitch about how an absent coworker made for a shitty day at work when everyone at work could read about it. I'd have to only write about certain things. I'm sure I could do still get some good writing done, but it wouldn't feel quite as authentic.

For example, if everyone knew about my blog, then I couldn't write about how sometimes I think I'd be better off single than in a relationship. I'm sure my girlfriend wouldn't be too pleased by that entry. Sometimes I do feel that way though. It doesn't mean I want to break up with her. It just means that I'm not entirely sure what I want just yet. Or maybe it means that even people in committed, caring relationships sometimes wish they could have the personal space of a single person. It doesn't mean they don't leave their significant others. Sometimes it just feels good to be your own person and not have your entire identity intertwined with someone else.

I can't have that conversation without this blog though. However, I crave that kind of conversation. I like examining those deep thoughts and putting them out there for people to think about and comment on.

Anyway... I just wanted to get something written. Maybe that will spur some more writing in the near future.

This Is Why Pharmacists Are Suspicious of ALL Narcotic Prescriptions

A couple weeks ago a woman called our pharmacy asking if we had Oxycontin 60 mg in stock. We informed her that we did, but the only tablets we had were of the old formulation.

I swear that she couldn't have been more excited if she shouted Eureka! into the phone. "I'll be right down," she said.

A few minutes later, this perfectly able-bodied woman shows up at our pharmacy counter with a prescription in hand for the Oxycontin. "How much is it for 30 tablets?" she inquired. Surprise, surprise... She wanted to pay cash for them.

We looked it up, and she decided 30 was too expensive for her, and she wanted to know the price for 25. Apparently, 25 tablets wouldn't completely wipe her out, so she then asked us to fill it for 26 tablets.

To enlighten those of you who might be uninformed about drug prices, 26 tablets of Oxycontin cost in the neighborhood of $200. Moreover, the script was from a doctor's office located over an hour away, and she was a new customer to us. There was no way this prescription could be legit. Therefore, we called the office to find out just what was going on.

The nurse gets on the phone and she listens as we tell her how shady this woman appears to be. The nurse checks with the doctor and a couple minutes later, she returns to tell us, "Dr. Dipshit said you can definitely trust her."

OK... Whatever he says. So we document the shit out of the situation, and fill the script for her 26 Oxycontin. Several minutes later, she returns to the pharmacy counter holding about $200 in cash, and proceeds to slap $20 after $20 on the counter as she pays for the prescription.

Yeah... Really trustworthy.

A couple weeks later, the woman calls our pharmacy inquiring once again if we had Oxycontin in stock. Once again, we did, and once again, she gleefully remarked that she'd be down in a few minutes.

Same prescription from the same doctor, only this time, the full 30 tablets would be just fine. Little did she know, she had nearly wiped us out of the old formulation last time, so we had to dispense the new formulation to her. I decided not to tell her this little fact because I was curious to see what would happen when she found out.

The technician went to ring her up at the register, and she almost had a heart attack because the price of the tablets was $22 more expensive than she thought it would be. "That must be some kind of mistake," she proclaimed. "Is that the new formulation?"

I confirmed her suspicion, and she immediately asked whether we had any of the old formulation left. Alas, we only had 10 tablets left, not enough to fill her script.

"No problem. I'll just take the 10," she responded.

Yup... completely trustworthy.

In the end, she did us a favor because she helped us get rid of all the old formulation tablets we had left. In addition, I'm reasonably sure that she'll never come to our pharmacy ever again.

Here's the thing though... All you people out there who have legitimate reasons for taking narcotics don't realize that these kinds of stories are closer to the norm than the exception. We fill ridiculous amounts of Oxycontin and oxycodone prescriptions and a good majority of them are for very sketchy people. However, every time we call the physician, we get the same response. "Yes, fill the prescriptions."

Just recently we had a guy and his buddy come to the pharmacy both presenting prescriptions for 240 tablets of Oxycodone written on the same day by the same out of state doctor. We called the office, and they didn't understand why we'd be questioning it. Yeah... two well built young men who happen to be friends getting the same narcotic prescription for massive quantities from the same out of state doctor on the same day. I have no idea why that's suspicious at all.

How about the woman who takes Percocet 7.5, Avinza (extended release morphine), and Exalgo (extended release hydromorphone) twice daily? We called the office wanting to know not only why she's taking two different 24 hour extended release narcotics, but also why she's taking one of them twice daily. Moreover, she has a sister that goes to the same office, and the doctor writes Avinza, Percocet, and Tylenol with Codeine prescriptions for her as well. The nurse didn't take too kindly to us questioning these pain management regimens. In fact, she was quite annoyed.

How about the woman who was getting 120 Vicodin a month from one doctor and also getting 90 Percocet a month from another doctor? We called to let one doctor know she was getting pain meds from another doctor, and we were told that they were aware of the situation. You see... She's taking the Vicodin during the day, and the Percocet when she needs pain relief at night. Oh, I see... I totally should have figured that one out. After all, it's not at all unusual for someone to chew through 120 Vicodin and 90 Percocet per month, especially if the Percocet is only supposed to be taken at night. Completely normal.

See... the biggest drug dealers in this country aren't slinging dope on the streets or cooking up meth in a basement laboratory. They're actually the doctors who will write for whatever narcotic patients ask for as long as they say they're in pain. As pharmacists, we're told that we have to be constantly vigilant for signs of drug abuse and misuse. We're forced to keep tabs on pseudoephedrine because it's apparently OUR job to stop meth junkies and sellers from cooking up meth in their basement laboratories. We're encouraged to use controlled substance databases to help reduce doctor shoppers and people who pay with cash at multiple pharmacies. Our license could be on the line if we don't document that we at least tried to verify any suspicious prescriptions. However, prescribers have free reign to allow patients to basically write their own prescriptions for narcotics.

My biggest issue is if doctors don't care, then why do I have to care? If they're prescribing habits are going to facilitate drug abuse, then why do I have to try to clean it up? I just can't seem to figure it out.

My Technician's Kid Gets Sick Means I Work More

This is a serious question to all you working parents out there: What do you do when your kids get sick?

I need to know how the normal person handles this situation because I can't imagine that every single time one of your kids get sick, you call out of work to take care of them. That's what happens with one of our technicians though. She has 3 kids, and every single time one of them has a sniffle, she has to stay at home and take care of the little cretin. She only works 3 six hour days per week, and I can't even remember the last time she went 3 weeks in a row without calling out at least once.

As you can imagine, a technician constantly calling out in a busy retail pharmacy kind of sucks. In fact, it pretty much screws the rest of the staff. Case in point, the last 2 days, I've had to stay well past when my shift was supposed to end because we were short staffed all day and constantly behind.

This really pisses me off. Why does her kid getting sick mean I have to work my ass off even more than I usually do in order to pick up the slack left by our absent employee? I've written before about how much I hate when people call out sick. However, this is even worse because she's not even sick and calling out. It's her fucking kid!

The kid is 13 years old by the way. I just wanted to give additional context. To me, a 13 year old is perfectly capable of taking care of himself at home for a few hours. I know I did when I was 13. However, her 13 year old isn't allowed to be home alone.

While I'm ranting and raving here, let me state as clearly as I possibly can that I don't care about anyone else's kids. They're not my kids. I don't care what they do. I don't care if they suddenly drop dead. However, despite my not wanting to have anything to do with them, they certainly seem to be able to interfere in my life. If I wanted to worry about and be inconvenienced by kids, I'd have some of my own.

Oh, by the way... Driving kids from one activity to another is not hard work! And every time I hear someone complain about having to spend all day playing taxi for their kids' extra curricular activities, I have to fight the urge to unleash an expletive laced tirade. You think driving a car from one place to another is hard work? TRY MY JOB! Try standing on your feet for 12 straight hours with barely a 10 minute lunch break (if I'm lucky) while trying to do 5 things at the same time with the phone ringing all fucking day long. Carting your fucking kids around would be a goddamn vacation for me.

I'm just tired of this shit. I killed myself at work the past 2 days (and have done so plenty of other times over the past 4 years) simply to cover for someone else. Where is the reward in all of this? Most of those extra hours go unpaid, so it's not like it benefits me financially. I don't get extra time off to compensate for working so damn hard. My job is only as secure as the amount of seniority I have in the company (which isn't a whole lot). There are no promotions, so there's no room for advancement.

You want to know the worst part though? The harder I work, the less everyone else works. I used to think there was such a thing as leading by example. You work hard, and everyone else will see your example and do their best to match it. That doesn't really happen though. If people see me constantly do something, they just assume that I will always do it. Therefore, instead of doing it themselves, they'll just leave it for me to do for them. And I always fucking do because I know it has to be done, and it bothers me to not do the absolute best I can.

I'm telling you... I'm getting closer and closer to the breaking point. If I do snap one of these days, I just hope whatever I do really inconveniences someone who has kids.

"You're Lucky to Have a Job"

I should be sleeping right now. I have to get up less than 6 hours from now in order to get ready to open the pharmacy tomorrow morning. I just really felt I had to get this post done. I've been wanting to write it for a week now, but I've been putting it off for various reasons. Anyway...

A couple weeks ago, I had a particularly rough day at the pharmacy. Nothing went right. A technician called out. We were incredibly busy. There was one insurance problem after another, and the phone would just not stop ringing! I was going insane.

Finally, with about 30 minutes left in the day, things started to settle down, and I got a little quiet time to finish up some paperwork that I didn't get a chance to do earlier. I started ranting to one of our technicians about how something has to change in this pharmacy because I don't know how much longer I can deal with all this crap.

She listened for about 30 seconds before saying, "well, just be happy you have a job." You see, working at the pharmacy is her second job, and she doesn't get paid particularly well for it. It was supposed to be something to supplement her income. However, she's getting laid off at her primary job. Without her primary source of income, she's unsure if she can make ends meet.

This made me feel kind of stupid for ranting about my situation to her. After all, she was right. I do have a job, and I get paid quite well. A lot of people would kill to have my salary, especially at my age.

However, later that night, I got to thinking that there has to be a point where "you're lucky to have a job" no longer applies. I understand that a lot of people don't have jobs. I understand I'm very fortunate to be paid very decently. However, just having a job and being paid decently shouldn't preclude me from complaining about shitty work conditions.

By the "lucky to have a job logic," my company could force me to fill 1,000 prescriptions per day by myself without any help at all while dealing with all the customer complaints and all the phone calls, and I'd have no reason to complain because at least I'm employed and making 6-figures. At some point, the stress reaches a level where it doesn't matter how much damn money I make, I'd rather be unemployed and broke than be treated like shit.

I can't think of a single profession that forces you to multi-task more than a pharmacist does on a daily basis. At a busy pharmacy, there's always 5 or 6 things going on at the same time, and the pharmacist is responsible for directly supervising EVERYTHING. While we're trying to fill prescriptions, the phone is ringing. It's a doctor calling in a script, and only a pharmacist can take that call. However, there's also a customer at the counter that wants to ask a question that only the pharmacist can answer. While trying to decide which to attend to first, the prescription for Celebrex you were typing into the computer just came up "prior authorization required," which means that you have to send a fax over to the doctor's office in order to let them know they either need to call the insurance company or switch it to something else. Naturally, the guy in line after the customer asking the question is looking to pick up that Celebrex prescription...

This goes on ALL DAY LONG, and it happens EVERY DAY. Oh yeah, and while you're trying to handle these pharmacy tasks, you just got an email saying another drug has been recalled. It's the third one of the day, which means for the third time, you have to check your shelves, quarantine the recalled product, and fill out the paperwork that corporate requires. The next email is telling you about the Aetna audit that's taking place next week. You have to make sure to make all those prescription files available for the auditor. And the warehouse is out of vial caps for the second time this week, and since you're running extremely low on them, you have to call a bunch of other stores to hunt down some that you can borrow.

Between filling prescriptions, dealing with customers, dealing with doctors, handling insurance issues, and following corporate policies, you're head is spinning all day long. You're constantly racing around. You work 12 hours without a proper break. You just briefly pause for 5 to 10 minutes to scarf down a sandwich, and then it's back to the grind.

And know what your reward is for busting your ass all day? Customers complaining, "20 minutes???? Is it really going to take THAT long??!?!?"

However, community pharmacists can't complain about this because, hey, at least we have a job, and we make over $100,000 per year. We should just shut up and take it because we're "lucky" to have the opportunity to be overworked and overstressed.

That's what the chains count on though. The reason they can get away with this crap is because, at the end of the day, most of us subscribe to this lucky to have a well paying job mentality. We hate the work, but we're addicted to the money, so even though we may complain, we won't do anything to really rock the boat and risk that paycheck.

I'm guilty of this. I want to quit my job so bad. Sometimes I actually get a little giddy imagining myself just walking right out of work one day and never coming back. I'm scared to death to do it though. I've become accustomed to my paycheck. I'm used to not having to pinch pennies. I'm used to just going out and buying what I want without having to worry about whether I can afford it or not. I'm addicted to the money.

Because of this addiction, my employer has me by the balls. They know that as long as they keep the money coming, I'll put up with whatever extra responsibilities they throw at me. The money provides an illusion of freedom when in reality, it is the thing that imprisons me.

However, I feel like I'm very close to boiling over. I'm not quite there yet, but I feel like soon, I'll reach the point where the money just isn't worth it anymore. It would be scary, but losing this job might be the best thing that could happen to me. It would be the kick in the ass that I need to find something that I'm happier doing.


***I said I was done writing here. However, I guess I haven't quite run out of things to say. I'm sort of feeling the urge to write recently, which is probably a sign of mind not being at ease. In any case, if I have something to write about, I'll write about it.***

Another Prescription Error That Could Have Easily Been Avoided

I'm going to turn this blog into ranting and raving against the forces in our profession that seek to put the public in danger. My focus will be on prescription errors, and how often the simplest of things can help avoid them.

Our pharmacy had another prescription error last week. This one, to my knowledge hasn't been reported to the Board of Pharmacy. Although, I almost wish they would report it because I would go before the board intent on kicking up a shit storm.

A customer presented to our pharmacy counter carrying 3 prescriptions. For the sake of this entry, we'll say this customer's name was Thomas Richards. Thomas has been on pain medication for quite some time. He's had several recent procedures that have required him to get a number of different pain meds. His need for opioid pain medication is perfectly legitimate. He is not the problem here.

The 3 prescriptions were for 3 different pain medications. They were from the same doctor's office, written in the same pen, and given to the patient at the same time. The technician at the drop-off counter, added Mr. Richards' date of birth and address to all 3 prescriptions, and told him the scripts will be ready for pick up in about 20 minutes. Everything was seemingly going smoothly.

The other pharmacist on duty was the one who inputted the prescriptions into the computer. He noticed that the doctor had given Mr. Richards prescriptions for MS Contin, Dilaudid, and Percocet. He wondered out loud why the doctor would give this patient both Dilaudid and Percocet. However, since that office is an orthopedic group, and we see a ton of interesting pain med combinations from them, we just kind of shrugged it off. I've seen patients get prescriptions for Percocet designated for moderate pain and Dilaudid designated for severe pain. It's not that common, but not unheard of. Therefore, we decided to just let it go. After all, it wasn't like they wrote the scripts for large quantities, and Mr. Richards was certainly in pain.

Twenty minutes later, Mr. Richards comes back and his prescriptions are all set for him. He pays and goes on his merry way. Several hours later, he calls the pharmacy saying we made a mistake. He said that the prescription couldn't have been for Percocet because he gets very ill when taking it. The doctors know that and wouldn't prescribe him that. The script was supposed to be for Flexeril.

I look back and double check the prescription. It most certainly said Percocet 5/325. I quickly checked the name and date of birth (that we had to write on the prescription when he dropped it off). Yes, it was filled correctly. Mr. Richards sighed and muttered something about the dumb doctor's office, and hung up. A little later the prescription for Flexeril was callled in to us. I guessed that he must have let the office know of the mistake.

Several days later, we get a call from that office. "The prescription you filled for Thomas Richards for Percocet was filled in error," proclaimed one of the nurses. "Mr. Richards was never prescribed Percocet. That prescription was for Thomas RICHARDSON."

Sure enough, when I went back and triple checked the script, the name on the top was Thomas Richardson, not Thomas Richards. It was a prescription error.

However, let's back things up just a little bit. How the hell did Thomas Richards get Thomas Richardson's prescription?

You see... This is a practice that I think is unfamiliar to the general public. Doctors don't actually physically write most of their prescriptions. They usually have a nurse write them, and then they sign their names at the bottom. We see it ALL THE TIME. The patient's name and all other prescription info will be written in these big, bubbly, girly looking letters, and the doctors signature is scribbled at the bottom. It doesn't matter whether we're talking about prescriptions for blood pressure medications or for Oxycontin. Many doctors don't write their own scripts.

Secondly, the only conceivable way that Mr. Richards was given Mr. Richardson's prescription was if the prescription was written out ahead of time and stored in some kind of file at the doctor's office. Obviously, the doctor or nurse did not see Mr. Richards and Mr. Richardson at the same time. If he was only writing for one patient at a time, there's no way that one patient could have come into contact with another patient's prescription. The only possible way was if a nurse had to sift through a file to find Mr. Richards prescriptions, and it just so happened that Mr. Richardson's script was mistakenly filed under the wrong name.

Moreover, the patient's address and date of birth was not written on ANY of the 3 prescriptions for schedule II controlled substances that Mr. Richards dropped off. The technician at drop-off had to inquire to the patient's address and DOB, and she was the one that wrote them on all 3 prescriptions.

Therefore, when the scripts finally made it to the pharmacy, all 3 of them were written in the same pen, from the same doctor's office, on the same prescription blanks, dropped off at the same time by Mr. Richards, and all had the same address and DOB on them (because the tech wrote them in on all 3). However, one was for Mr. Richardson instead of Mr. Richards.

The nurse who called to tell us about the error gave me the "YOU FILLED IT WRONG!" attitude, and quite frankly it really pissed me off. Yes, I suppose ultimately, it was a pharmacy error. However, the patient, the technician, and 2 pharmacists both looked at these scripts and didn't notice the slight difference in the name on one of the prescriptions.

It goes down as a pharmacy error, but if the doctor had A) not written the prescriptions ahead of time, and B) had included the patient's address and DOB on every prescription (which by LAW, they are supposed to), we would have easily caught the mistake.

It's just another incidence when pharmacies are the ones getting shit on for prescription errors, even though we're seemingly the only entity in all of health care the gives a shit about doing things to prevent them. Every time a doctor writes sloppily, every time he uses unapproved abbreviations, every time he doesn't include the patients date of birth and address on the prescription, and every time he doesn't provide his DEA #, there is a chance for a prescription to be either misfilled or therapy to be delayed to a patient due to the pharmacy's attempt to try to fill in the missing information.

Everyone laughs about doctors' messy handwriting. It's a big fucking joke. The public just assumes that's the way it is, and it isn't going to change. If the pharmacy can't read what the doctor writes and has to call to verify a prescription, the patient gets mad at us and not the doctor. The public jumps all over pharmacy mistakes, but the doctor can write illegibly, prescribe the wrong dose, wrong drug, or a medication with a significant drug interaction, and the public just shrugs it off.

Why is everyone so afraid of doctors and people in their offices? People come in and treat the pharmacists and pharmacy staff like dirt on a regular basis. They yell and scream about customer service. They look to us to fix everyone else's mistakes, and then get mad at us when it can't be done in 5 fucking minutes.

I'm sick and tired of it. I really am. I can't be the customer service representative, insurance trouble shooter, I.T. help desk, store printer technician, cashier, secretary, business manager, AND pharmacist at the same time. Every time you interrupt me with something that isn't related to verifying the safety and accuracy of prescription orders, the chances of someone being harmed by a pharmacy error increases. Every time my District Manager requires me to personally walk customers directly to any item in the store that they might be looking for, I'm interrupted from possibly teaching someone how to use an inhaler or inject insulin.

I'm a pharmacist. I'm not a fucking customer service rep. I'm not a fucking cashier. I make sure prescriptions are safe, accurate, and that patients know how to use them. Everything else is superfluous. I don't give a shit about the fucking inventory being over budget. Get an ordering department. I don't have time to spend 2 hours on the phone with an insurance company to get a claim to go through that provides a $2.50 profit. Get a billing department.

I know I'm kind of ranting off topic now, but my overarching point is that we're asked to do too many things at one time, and even asking other medical professionals to take literally a few extra seconds to write patients' addresses, DOB's, and prescribers DEA #s on prescriptions seems to be too much of a hassle for them. It would literally take 5 extra seconds, but they can't be bothered, and because they can't be bothered, the chances of pharmacy prescription errors increase.

If you're a prescriber reading this, and you're one of these fucks that don't take those 5 extra seconds, FUCK YOU! Seriously, you're scum. You make pharmacists lives miserable because you're too fucking lazy to do what you're supposed to.

The Anatomy of a Prescription Error

It should be an easy day. It's a Thursday. Thursdays are never really that busy in this pharmacy. The big order doesn't come until tomorrow. You don't have to create an order. It's in the middle of October, and while flu shots are really starting to pick up, you haven't had enough of them to really impact your work day.

You're scheduled to be at the pharmacy at 10, so you have plenty of time to sleep in. You get up at a decent time, have a nice breakfast, and even get some exercise in before showering and getting ready for work. You're nice and relaxed, and you truly feel that this will be a good day.

When you arrive at the pharmacy and take that first step through the door, you come upon what looks like a disaster area. Labels are all over the place. There's a long line at the register. The other pharmacist is hung up on a phone call, and the lone technician is getting frustrated dealing with a customer. No, the customer is not being rude. He's simply having an insurance problem that the technician, despite working in the store for 25 years, has no idea how to solve... mostly because she's completely computer illiterate.

You see... The pharmacist scheduled to open the store that Thursday got there 10 minutes late. Therefore at 10:00, a full 2 hours after we open, all the scripts that were left on the refill line overnight still were not finished, and those labels were in no particular order all over the pharmacy counter. That one technician, despite having all that experience and being full-time, has never counted a prescription or typed a new prescription. She's basically a highly paid cashier.

Before even taking off your jacket, you walk over to the computer to help the technician. It takes you less than 30 seconds to solve the problem that had frustrated her for the last 5 minutes. Afterwards, you hang up your jacket, take a deep breath, and get to work. No time for pleasantries. No time to get settled. You jump right into the fray in an attempt to get the pharmacy to the point it should have been over an hour ago.

However, it's never as easy as just putting your head down and filling scripts. The second technician was supposed to be in at 10:00, but at 10:20, she's still not there. Therefore, you're forced to constantly jump between being a pharmacist and the world's highest paid cashier. Finally, at 10:30 the second technician strolls in. There's no explanation for the tardiness, and quite frankly, you don't have the time to listen even if there was one, so you just keep chugging along.

Just when it looks like you're starting to gain some control, the phone calls start coming. The other pharmacist (the one that showed up 10 minutes late), is the floater scheduler for the district. He has to get that floater schedule out by Thursday of every week. However, the stores for which he schedules and the floaters that work in them are such major pains in the ass that he has to constantly revise the schedule all week. Therefore, in the middle of this crazy Thursday, he has to stop for 10 to 20 minutes at a time to handle scheduling emergencies. That leaves you to work the bench alone.

The scripts keep piling up, and on this day, the customers seem to be in extra need for pharmacist attention. You do your best, but you're only one pharmacist trying to do the work of two without much help from your cashier-level technicians. Now, the other pharmacist gets called upstairs to speak to the main store manager, so he disappears for a good 20 minutes. At this point, frustration is really starting to set in.

The wait time at the pharmacy is usually no more than 20 minutes, so when dropping off scripts, the techs/clerks habitually tell the customers it will take 20 minutes for their scripts to be ready. Realizing that you're so far behind that there's no way you can fill new scripts in 20 minutes, you tell everyone that the wait time is now AT LEAST half an hour. The next technician/customer exchange goes something like this:

"The wait time is 30 minutes, but it might not actually be that long. We're just really busy, so we're just telling people 30 minutes, but it will probably be done before that, so stop back and check in a little bit."

Therefore, despite the at least 30 minute wait time, customers routinely return to the pharmacy counter in 15 to 20 minutes. Upon return, the technicians apologize to the customer that it's not ready yet, and then both the customers and technicians look at you expecting you to drop everything you're presently doing to finish their prescriptions. You don't want to, but you can't help but start rushing in this situation.

One customer wants his Suboxone prescription that he dropped off 15 minutes ago. It's for a box of the film strips, so you think it's a quick one. You find the label, grab a box off the shelf, label it, and send the customer on his merry way relieved that you no longer have to look at him.

Eventually, the other pharmacist returns to work, and you steadily grind down the mountain of prescriptions. At the end of the day, you actually filled only slightly more than normal for a Thursday, but it felt like 10 times that. Exhausted, you go home and pass out without even eating dinner. The only thought in your head is that you have to rest up, so you can be at the pharmacy at 8:00 the next morning to do it all over again.

Over a month later, a doctor calls you up inquiring about one of his Suboxone patients. The guy was complaining about having withdrawal symptoms and needing to increase his dose. The doctor couldn't understand why after being stable for so long the man was suddenly going through withdrawal, so he wanted to check with the pharmacy to see if you could perhaps shine some light on the mystery.

This month, the patient received the 2 mg Suboxone, just like the doctor ordered. However, the previous month, he got the 8 mg dosage. In fact, that was the only time he ever got the 8 mg dosage. Upon checking the prescription, you find that your initials are on the hard copy of a prescription that was filled in error. The man got 4 times his usual dose because instead of dispensing the 2 mg to him like he always got, you dispensed the 8 mg film strips.

Your error, while thankfully not harming the patient, caused the doctor to have to alter his treatment plan and increase his dose to accommodate for his withdrawal symptoms. The doctor reported the error to the state board of pharmacy, and 3 weeks later a drug control agent wants to speak to you about the mistake.

In the end, you don't suffer any serious penalties as no one got hurt, and it was your first offense. However, it's still embarrassing because you know how hard you work and how serious you are about being accurate. You're professional about the whole situation. Your initials are on the prescription. You missed the check. It's ultimately your fault, so you take the blame. However, you know that there were a lot of factors that contributed to that error. It wasn't just carelessness on your part. The error was part of the retail pharmacy culture that promotes speed, volume, and business-related paperwork over accuracy and patient care.

You were lucky this time. No one got hurt. Maybe the next error won't come with such good fortune. All you know is that you don't want to be around to find out.

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.)

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.

"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.

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?

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: “http://www.menshealth.com/men/health/heart-disease/saturated-fat/article/a03ddd2eaab85110vgnvcm10000013281eac.”

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.

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.

"Cough"

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.

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.

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.

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.

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.

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.

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.