Pharmacy. Jim Plagakis. Pharmacist

I am mailing this letter to the next confirmed Secretary of HHS. I am not holding out much hope, but what you and I see every day, the waste of $$$$ resources for prescription drugs, is something that I want to see HHS discuss with us, the pharmacists with our feet on the floor in the pharmacy.

She Hate Me

I think that we could open the eyes of the secretary about PBMs, their refusal to pay for vital treatments and their paltry reimbursements. In the end, they do nothing to assure their premium payers good health and welfare.

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Tell me what you think. Am I just blowing smoke? I had to do this. My conscience would not leave me alone. Now, I can rest. I took my shot. Why not take your shot.

Secretary
The US Dept of HHS

Unlawful Entry

200 Independence Ave. SW
Washington, DC 20201

1/29/09
Dear Mister Secretary,

The delivery of health care to the American people has been hit and miss for the last eight years. Many patients have been neglected. Others could not afford even basic care. Medicare Part D is a cruel and difficult landscape to navigate for too many. I believe that there is a chance for it to get better with you running the show.

My name is Jim Plagakis. I have been a practicing pharmacist for 43 years. I have written the Drug Topics magazine column JP at Large for 20 years. My view is from the inside.

More than $2 trillion per year is spent for medical care in our country. Much of this is wasted. Consider that the biggest drains are over-utilization and the middle man.

Patients with insurance take prescriptions that are no longer necessary. Doctors order MRIs for sprained ankles. Old women get dressed up to go to their weekly doctor appointment. They are not ill. It is a social event. They see their friends. The doctor gives them a few minutes and bills Medicare.

Insurance companies take in a dollar in premiums and dole out eighty cents in payments. For the twenty cents they keep for themselves, they provide absolutely no medical care.

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Mister Secretary, when the discussion comes to prescription drugs, the cost and the delivery, I urge you to consult pharmacists who actually work in pharmacy departments. Pharmacy owners have their own, unique view. You will not get a clear look from discussing matters with the executives from Rite-Aid or CVS. They do not see what we see.

I am only one of a network of working pharmacists with a clear vision. Please call on us to serve.

Sincerely,

Jim Plagakis, R.Ph.

Harold Cohen is a pharmacist who is the Editor-in-Chief of the magazine U.S. Pharmacist.  Harold and I have had a working relationship in the past.  He was the Editor of Drug Topics magazine.  Harold writes a monthly column called Straight Talk.  He spent two decades in retail, so his voice often rings true. I found Harold’s January, 2009 offering to be interesting.

He called it The Invisible Pharmacist and he was talking about health system pharmacists.  I have often wondered what a health system pharmacist is.  Drug Topics puts out health system supplements on occasion and they always went into the round file.  Nobody has told me that I am a health system pharmacist so I must not be.  After reading Harold’s column, I determined that a health system pharmacist is what I have always called a hospital pharmacist.  There, knowing that, I don’t have an inferiority issue about health system pharmacists anymore. 

Harold talks about hospitals having “state-of-the-art technological marvels that few retail pharmacists can really appreciate.”  He talks about bar coding and scanning to assist in preventing errors like health system pharmacies have a singular domination of modern equipment and methods.

Not so.  Not so, at all.  There are chain drug stores all over the place that scan and barcode and check and recheck and scan again before a prescription gets to the patient.  Same with automatic dispensing cabinets.  Okay, Harold, I agree that “the counting tray found in many retail drug stores looks like an abacus next to a computer”.  The independent that fills one hundred prescriptions a day with basic pharmacy software does not need dispensing cabinets. 

I get the feeling that Harold believes that health system pharmacists are somehow better than you and me and the tens of thousands of us poor bastards who are stuck in retail.  I wonder if he thinks we suffer from health system envy.  I have yet to drive by a hospital and see envious pharmacists with itchy feet on tiptoes peeping wide-eyes into the windows of the hospital pharmacy.

Harold reports that health system pharmacists are no longer “stuck in some out-of-the-way basement of the hospital.. with no patient interaction.”  The following high-sounding sentences indicated that health system pharmacists actually talked to patients. 

Down in the Valley full

At least I think that is what he wanted to say.  You read it and tell me what he said.

What does he think?  That you and I are limp bisket pharmacists?  Harold saves himself at the end.  He lumps all pharmacists together as coming from the same mold.  He labels all of us well-trained professionals. 

I now know what a health system pharmacist is and I am not impressed.  I cannot imagine a hospital pharmacist having to multi-task like you at the retail shop.  Retail pharmacists are the real superstars of our profession.  We get it done regardless of the working conditions.  You are the VIPs.  You make interventions that benefit your patients every day and you do it in between bites of the stale cheese sandwich.  You are not chopped liver.  You are the Retail System Pharmacist. 

I will make a recommendation to independent pharmacy owners.  You have absolutely no time to waste.  You can’t think about this.  You better not hide your head in the sand or you will lose patients by the bagful.

So far, the $4.00 Rx has not killed most of you off because you do not have that many cash-paying patients.  That is about to change.

Medicaid roles are surging, by unprecedented rates.  That means that for every family that has the bread-winner laid off and can qualify for Medicaid, there is a number of people who lost their jobs and do not qualify for Medicaid.  (NYT)

COBRA, you ask.  Has anyone ever told you what the premiums are to COBRA the insurance they had with the employer who laid them off?  Only one in ten signs up with COBRA. (NYT)

10%.  The 90% just roll the dice, neglect conditions and illnesses and end up needing more prescriptions.

You are going to have good customers go elsewhere to get the $1.00 a week generics.  These are people who have been with you for years.  They won’t even ask you about $4.00 generics because they know that you won’t sell your prescriptions that cheap.

You are a good person.  They like it that you know them by first name.  They have brought you cookies at the holidays.  They stop you in the grocery store.  You see them at the high school games.  But, my friends, the family has to eat.  Family budgets will be very tight for months, maybe years.

More foreclosures.  Families in homeless shelters.  Expensive pickup trucks repossessed.  I know that I am painting a dark picture, but it is very dark out there.

They are embarrassed that the dad is out of work.  The job he takes delivering pizzas does not have benefits.  The mom is going to figure out very quickly that she will have $9.00 dollars left in her thin pocket book by getting dad’s atenolol for $4.00 rather than the $12.99 that you charge.  And, with the atenolol go all of the family’s prescriptions, their shampoo, shaving cream, everything.  You will have lost them for good.

The $4.00 Rx is not going away.  You are going to have to copy it or come up with something.  We will have it until there is a single payer system in place.  By then, it may be too late for you.  Just don’t waste time.

The last thing you want is for the general public to start perceiving the $4.00 purveyors as public health angels and you the ‘price-gouger’.  When that happens, it is all over, my friends.  You may as well close the store.

I have been practicing yoga for almost three years.  It is the best thing I have ever done for myself both spiritually and physically.  It is very nice to have V along with me.  We lost a brilliant instructor due to the storm.  Her studio took 10 feet of water and mud.  She had no insurance and is now back in Santa Fe, New Mexico, close to family and her own teacher.  We found out quickly that Kathleen prepared us well.  We are able to practice yoga, on our own.

 

Our largest ( 10’ x 14’ ) storage room down where “Ike” hit us, is now a carpeted “yoga room”.  It is quiet and our practices are robust.  We have found that the room is a nice place just to sit and talk or sit and not talk. 

 

Kriya Yoga is a very intense school of practice.  I skirt way out on the edges.  I share some of the milder health practices of Kriya Yoga with my patients and they don’t even know it.  I do not run a cotton cord up one nostril and out the other to clean the sinuses.  I do not swallow a 50 foot cotton swab to clean out my intestines.  I don’t drink my urine every morning.  I mean, get real.  This is 21^st Century America.

 

When a patient presents with constipation, I always recommend the allopathic remedy that I believe is appropriate.  I also ask them this question, “Do you eat meat and dairy products?”  I always tell them that it is best to eat moderate size meals, mostly plants and plant products. 

 

They always ask me if I am a vegetarian.  “No, I am not a vegan either.  I eat meat, just not very often.  New Years Eve, I had three slices of premium ham with mustard between two slices of rye bread.”  I enjoyed it very much, but I avoid food that putrefies.

 

I use this example when they ask about purification.   When you go away for a weekend in August the house can get to body temperature, the high 90s.  On the counter in the kitchen, leave a pound of hamburger, a quart of milk an apple and a head of cabbage.  When you get home, tell me which foods rot.  I tell them that this is what happens inside of them.

 

Hey, leave me alone.  I can do this if I want to.   You can recommend Metamucil, Senna S, Fleets and prime rib.  You can customize your practice of pharmacy exactly the way you want it to be.  You can end “Cookie cutter pharmacy” any time you want.

 

Galveston has been a dirty place after Hurricane Ike.  We had bugs that I had never seen in Galveston before.  The mosquitoes swarmed all around you in the evenings.  The houseflies were big and fat and slow moving.  There were gnats everywhere.  They got in your nose.  Workers who spent their days tearing out mold infested sheet rock in buildings that had been swamped with sewage contaminated flood water came with skin infections. 

 

Staph was a serious problem.  Big strong men who were in the habit of washing only their hair, underarms and privates came in with ugly rashes.  I told them that they needed to wash better.  Every single inch of their bodies. 

 

Bacterial infections were an issue.  I have helped more people with boils in four months that I have in 43 years.  I shared Kriya Yoga with people with cuts and scratches.  I recommended that they do what I do.

 

I tell them to clean their bodies like they never have before.  I use an abrasive mitt and antibacterial body wash and scrub every inch of my body.  I swab Betadine Solution on the smallest nick. 

 

I have recommended this level of self hygiene ever since the storm.  I have had patients waiting their turn ask me to repeat what I just recommended.

 

Now, you tell me.  Is this practicing pharmacy?  Or am I some kind of Bozo trying to step beyond the traditional role? 

 

In 1964, my first year as an RPh, I was just a dispenser and a compounder.  I have re-defined my role during 43 years of practice.  It is like the tides of the Gulf of Mexico.  My role changes with the circumstances.  Plato said in The Republic “Necessity is the mother of invention”.

 

Go with the tides, you guys.  Use your experience and your knowledge to create your practice of pharmacy just like you want it to be. 

 

You are very smart people.  You got your BS or PharmD.  That is no small thing.  You have the chops to be much more than an over-educated clerk.  Step outside the traditional fences and start making the kind of difference you want to make. 

 

Start having fun in the Drug Store Corral

 

 

 

I got a call from a doctor in New Hampshire. He was calling in a prescription for his daughter who is a student at the University of Texas Medical Branch.

The prescription was for SMZ/TMP DS for UTI. He asked me how many tablets and for how long. He is a dermatologist. I told him that it is best to err on the side of too long rather than too short. I added that 3 or 4 days would probably be enough.

“Let’s go ten days,” he grumbled.

I asked him if he wanted anything else and, with attitude, he asked what I meant by the question.

“There is usually stinging and burning,” I said. “We can handle that with a couple days of phenazopyridine.”
Of course, he wanted to know all about it and I wished that I had saved the idea for the OTC strength. I was thinking of his daughter’s budget. The Rx Only version would be covered by her insurance.

He okayed the prescription and then asked, “Is there a lot of this kind of infection down there?” He said it as if he was referring to Yellow Fever. He made it sound as if he thought UTI was a sub-tropical Galveston thing.

“There is no more UTI here than any other place I have practiced,” I said.

“Well this is the fourth time my daughter has had a UTI in four months,” he complained. “She is a healthy girl. There is something wrong down there.”

“Give her a second prescription,” I advised, “With the directions of ‘Take one tablet after each sexual encounter.’”

There was a very long silence of the lambs. He cleared his throat. I knew what was coming. He could not handle the vision of a studly Galveston boy poised above his Princess. Along with the picture, he probably imagined the sounds and the aromas. Poor guy! And he is a medical doctor in the 21st century.

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“Excuse me,” he said, “My daughter is NOT sexually active.”

Superbad download “I’m sorry,” I said, “Some of the medical students down here are sexually active. My error.”

“Why do you think that my daughter is having sex down there?”

“I don’t think anything about your daughter. I just met her for the first time and why would she tell me, her pharmacist, that she is having sex.”

“That would be none of your business, mister, if my daughter was sexually active. I don’t want her to have anything to do with your ideas. Let me talk with another pharmacist.”

I told him that he was out of luck. “Doctor, I’m the only pharmacist here right now.” I let the silence linger. He was the aggressive side of the conversation. It was his serve.

“All right,” he said, “Her mother and I may have been too protective of her. Just the idea of her having sex with a stranger makes me sick.”

“He wouldn’t be a stranger to her,” I said.

“Have you met him?” His voice was pitched too high.

“No. She was with a female, another student.”

“Are they promiscuous down there?”

I didn’t like the DOWN THERE, like Galveston was a sex farm in Brazil. “Doctor,” I said and my voice was firm. “This is no different from Chicago or Cambridge. Twenty-something students are likely to be sexually active. This is 2009, not 1959. If your daughter isn’t taking oral contraceptives, she should be.”

“Why do you say that?”

“Because she might not be getting recurrent UTIs if she was using condoms.”

To make a painful story shorter, I will skip the drawn out education of a closed-minded father and just say that I suggested he turn this part of his daughter’s medical care over to her gynecologist.

“I don’t think she has a gynecologist.”

“She is 24 years old,” I said, “Ask your wife. Trust me. She has a gynecologist.”

Two hours later, I get a call from New Hampshire. It was the girl’s gynecologist. I did not like her unprofessional sharing of a good laugh at the dermatologist’s expense, but perhaps that is how they do it in New Hampshire. I found out that the girl had been taking an OC since she was a senior in high school. She gave me a new Rx for Yaz and an Rx for Nitrofurantoin. Enough capsules for a 5 day course for this infection and additional capsules for one capsule immediately after each toss in the rack, 30 of them.

Who said, ‘Father knows best’?

They don’t bring us pens and paper anymore.  They haven’t brought in a large, thick crusted vegetarian pan pizza with feta cheese and artichokes extra since around 1998.  They haven’t invited me to a hockey game since 1995.  The last time I was invited to a baseball game, including the tailgate party that started at 10:00 in the morning was in San Diego.  1977.   

What a day!  This “detail man” had San Diego beauties mixing with us.  He said that the three of them were younger sisters of a colleague.  I looked closely and I saw that they could be sisters.  I also saw that they were brilliant big hair examples of young and fit American females.  I asked the “detail man” later if they were really sisters.  He just smiled and refused to talk when I reminded him that the pharmacy manager of the Longs in La Mesa left the box seats on the third base line with the big hair red head in the 5^th inning.  These were swinging times in San Diego.

 

Let’s cut to the chase so I can go downstairs and watch the Eagles beat the Giants.  You know and I know that Big Pharma will spend enormous mounds of money to get prescribers to write for their products.   It seems that the budget is unlimited.  When you sell a pill that costs 5 cents to make for 5 dollars you have a lot in your coffers even after you pay the enormous development costs.  You will do just about anything, including getting doctors privately laid.  No, I don’t have evidence, but come on.  Don’t be naïve.  If they see morals and ethics in sending the Longs PIC home with the redhead in 1977, they will do it in the 21^st Century.   

 

Anything to sell their drugs.  Including ignoring research that may slow the sale of their premier drugs. Vioxx!  Bextra!  You can talk about that.  I don’t want to right now.

 

So, no more trinkets to doctors.  No pens to pharmacists.  No meals.  No tickets to The Nutcracker.  Nothing.  Not from Big Pharma.  They hardly even visit the pharmacists anymore. 

 

Little Pharma comes in because they can’t compete with Big Pharma.  They bring in all of the little gifts that we like.  They are usually pleasant young women.  If I can, I favor them.

 

Big Pharma doesn’t show up because they don’t have to.  They are putting their bucks where they can get the most bang.   DIRECT TO CONSUMER ADVERTISING on TV, in magazines and over the Internet.

 

Big Pharma has “detail people” just to fill in the cracks.  What better “salesperson” than a long time patient demanding your drug after seeing the TV commercial.  Men who barely had a problem take Flomax.  Doctors have gotten in the habit of barely discussing the matter before they get out their pads.

 

How can they fight this?  They are fee for service doctors.  They are not wage slaves at an HMO who can laugh a patient off.  It is imperative that Johnny Jay Johnson keeps coming back regularly.   Do you think that Doctor Campbell is going to refuse Johnny Jay, a south Texas macho redneck, when the big man demands an Rx for Cialis?  Never!  He refuses and Johnny Jay is gone for good.

 

This is challenging for us.  Another example of our industry being less and less an industry run by pharmacy.  There must be something we can do.  Direct to Consumer advertising could be a public health issue.  When TV creates a demand for drugs that will kill you if you take enough, often enough, we truly have lost control of our profession.

 

What?  Start a letter writing campaign to the APhA?   Yeah!   Sure!  Where have you been?

 

 

 

 

 

 

 

Now that you mention it, folks, does the company I work for qualify for “Jay Pee’s Seal”?  The answer is NOT YET even though this job is my dream job.  I work two eight hour shifts a week.  The scheduler has asked me to work more shifts, but now leaves me alone.  I will qs ad to three shifts a week as a favor to my co-pharmacists, but this is a rare week.

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I get an uninterrupted meal/rest break. 

I use the bathroom whenever I want and no one has said, “Will you check this first?”

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I have never seen the non-pharmacist store manager butt into pharmacy business.  When I told him that I did not want a certain tech scheduled for the late shift when I was on duty, he told me that the call was up to the PIC.  Gadzooks!  This was a store manager who was not interested in micro-managing in the pharmacy.  I had never experienced this before.

The PIC decides who works in the pharmacy.  Period.

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The one time that a totally unreasonable and just plain wrong patient jumped the new guy by running up front and grabbing a manager, I was treated with deference and respect.  I explained why I had refused to honor this patient’s demand and never heard another word about it.

To tell you the truth, I did not expect to get so comfortable so fast.  I have no idea how it is in other districts or even stores, but the company I work for is closer than any to “Jay Pee’s Seal”. 

The drive-through will probably doom almost everyone, but we can compromise, huh?

I have had two jobs that I loved.  My first one and this one.

My first was in a large independent on Main Street.   We had a long lunch counter.  Every Rx customer got a ticket for a cup of coffee.   I would go over and sit with them and talk.  I’d even sneak in counseling in a time when pharmacists were supposed to mind their own business.  I had a few “dates” with the camera department manager.  The store owner (who had a wife) “dated” her too.  That kind of testosterone-driven work benefit is not why that job was one of only two dream jobs.

I have had readers write to me privately and ask where I work now.  They want to check it out and see if they might want to sign on.  I have told them and warn them that it is a very big company.  What happens with this company in Vegas may not be what happens in Galveston, Texas.

I will not reveal where I work here.  That is that and this is this.

IAPharmr at 5:00 PM 1-8-09

He thinks that his company should be the first to be granted “Jay Pee’s Award of Honor for superior working conditions”

No drive throughs..  No Guilt Pee breaks.  Look and see ikf he claims to have a toilet room in the pharmacy…..Pharmacists are always managed by pharmacists……….. Pharmacists are not “knee-jerk” made the culprit when their is a complaint…  PIC is the decider in all matters pharma.

He isn’t getting a free fish.  The company has to talk to me.  I am not easy.

1/10/09

Okay, Cathy & SOSP. 

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I’ll add “Pharmacist Friendly computer software.   You tell me how you want it worded.  Simple & declarative pleaese.

 

 

 

I will have some fun. Maybe even make a few bucks.

I’m an older man. Gonna be 68 years old in three weeks. For you who are interested in things like this, I feel my age about two hours a day when I take a nap. I move very fast. I get a lot done, but I often start at 4:00 AM. I can’t keep it going all day.

I only work two days a week, but I have a full plate every single day. I rarely take a day off. For you older guys/gals, this is the thing to do. Dead people don’t do anything. It is alive people who keep on doing things. There are a lot of walking dead with their feet on the floor at the pharmacy.

I mention that because retail drug store companies need us old guys to work. We fill in the cracks and we bring a good, old-fashioned drug store merchant attitude to the store where we work. This is something that can be passed on.

We older men and women want our work place to be a comfortable place to work. I am going to offer an advertising opportunity to any or all retail pharmacy employers that can live up to my standards.

I will call it: “Jay Pee’s Official Employer Order of Merit for Superior Drug Store Working Conditions”.

My prediction is that the companies that make “Jay Pee’s List” will see their recruiting problems diminish. They will still have to pay “sign ons”, but they will be able to pick and choose who they want to work for them.

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What do you think I should call this award?

They will have to attest that they encourage:

“No guilt bathroom breaks”

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“Uninterrupted meal and rest periods”

“Pharmacists will be managed by pharmacists, never by non-pharmacist managers”

“Compensation over and above wage for providing extraordinary services like MTM & immunizations”

“It will NEVER be assumed that the pharmacist is at fault when a customer complains.”

“Drive Through windows may be closed by the pharmacist on duty when it is clear that staffing is not adequate and that keeping the window open would cause a multi-tasking environment that could endanger the health of the patients”

“The PIC will be the only manager deciding who will work in the pharmacy”

Okay, that is a start. I am open to your suggestions. My prediction is that a small grocery store chain that is failing at keeping competent and loyal pharmacists will be the first to bite.

1-8-09 nomination from Becky The Techie

“A quiet area will be set aside inside the pharmacy for message retrieval and doctor calls. A stool, chair, or bench and a table or counter will be available in this area for use of the pharmacist responsible for those messages and calls. These measures will increase accuracy levels, as well as expedite the necessary interactions between pharmacy and medical care providers.”

“Why do you do that so much, Jim?” said a member of the out-front management.

“What?” I was re-stocking a few OTC products that had been left on the pharmacy counter.

“I see you out front talking to customers all the time. The other pharmacists usually just tell them what aisle to go to. You practically take them by the hand. You take our private label off the shelf and put it right in their hand. I have heard you say, ‘Saving you money is my job’. Why do you do that?”

“I do it because I love it. It is a chance to make a difference. The private label is a no-brainer. The quality of the products cannot be questioned. It saves the customer money and the company makes a better return on investment.”

The ‘love it’ part gets more points on a scale of one to ten. I know that I have bitched mightily about not getting paid for providing valuable triage services in other places.

What I am talking about here are the warm fuzzies I get from helping people, the satisfaction I get when a worried mother’s face relaxes, the sincere ‘thank you’s I get when the meager offerings of their pocket book is able to afford an OTC that just might help.

I even pay sometimes. Sick of Stupid People writes big checks to help her patients who would have to go without. I don’t put out big money. I give a few dollars here, a few there, because it makes a difference. I sometimes think that we are, after all, the only medical professionals who see real, feeling, hurting human beings. The others see cattle.

On a Friday night, about 9:00 PM, a young woman asked how much her Rx for SMZ/TMP DS would cost. Her husband said that they had just enough, but it was in a safe place in the car. When I was talking to her while we waited for the money, I asked if she had any stinging and burning. (Have you noticed that these guys are not writing for phenazopyridine on a regular basis? What’s up with that? There is pain!)

“The stinging is terrible.” She frowned. Her husband was back.

“I can help that for less than six dollars,” I said.

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She looked at her husband who said, “I will only have about three left after I pay you.”

I paused. “I’ll pick up the balance,” I said. He paid in quarters, dimes and nickels. Their emergency money.

I got my wallet out and settled with the company. “Are you hungry?”

They looked at each other. “We’ll be okay,” the husband said.

“Where are you staying?” Galveston is a resort/vacation spot. They were from West Texas. Galveston? With no money?

“My aunt invited us down, but there was a note on the door. She is gone until tomorrow. We’ll be alright. The van is big. We’ve slept in it before.”

“Are you hungry?”

“Yes, we are.” They both avoided my eyes. I gave them a twenty.

Certainly not Saltgrass money, but there is a Taco Bell right down Broadway.

I felt real good. They may have taken Jay Pee, but it is on them. I paid some karma off. If they frikkin’ worked me and ended up in the van laughing at me. well.. it is on them. Bad karma. They will pay.
Is that practicing pharmacy? Yes, I think so!

Oh, the Rx came from UTMB emergency. This poor medical center has the 19th century duty to give free medical care to indigents from anywhere in Texas. It is not sustainable in the 21st Century.

Emergency! I can see the value of the in-store clinics where a nurse practitioner could prescribe SMZ/TMP DS for twenty bucks.

Why can’t they have cheap/free clinics where these people can go? Unnecessary Emergency Room visits drain the entire system.

I just needed to stretch out. I have a lot to say. You will too after you have had your-feet-on-the-floor in a pharmacy department for a few decades.

The old theme was just too restrictive. This one offers a lot of options for me and for you. What I want to do most is inform you, entertain you, humor you and have fun doing it.

The flowery meadow in the spring theme is apropos to my “love child” life in the San Francisco Bay Area. I was a weekend “hippie”. My hair was well over my ears. I wore the clothes. I talked the talk. I did it all except “drop out”. Gimme a break. I worked hard to get my degree and licenses. It was time to practice pharmacy and make some money.

I spent many Sundays sitting on the meadow in Golden Gate Park with sourdough bread, heavy red wine, cheese and salami. We listened to the free concerts. “The Dead”. “Janice”. “Havens”. One Sunday, I said to my wife, “They are playing Beatles songs.” It was the Beatles. Wine was my drug. Too much wine , but I was in my twenties. The drinking culture was still very strong in those days.

There are terrific stories from this time and I’ll tell them and many others. I have had both of my feet solidly in the drug store, pharmacy culture since my first job as a stock boy. That was 1957. That is 50+ years.

This main page, by the way, will remain a relatively purposeful commentary on our profession and the job of working in a pharmacy.

This will be like the ocean. A study of fractals that follow the tides. You watch pharmacy and it seems to be the same, like the waves, every day
until it is not the same. I like to watch for those episodes.

Some of you might want to avoid some of these story lines. There will be
“adult” content. I WILL WARN YOU. If you sneak a peek, I won’t tell. Those forbidden pleasures are the most delicious.

When you click on the pages up above look along the top margins for the sub-pages. There will be layers. Just keep looking until you find something that appeals to you. In order for you to leave “comments”, I’ll have to make every post a new page. So prepare to dig deep. The comments button is to the left, right below the date.

Explore. Right now we are “Under Construction”, but have fun.

PS: Just because I haven’t written anything yet for some of these pages, you can still write “comments” if you get motivated by the title of the page. Just have fun.

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