Pharmacy. Jim Plagakis. Pharmacist

This is a segue on the column below  (3-24-2005 Eating Our Young)

I’ll take both sides about the APhA and I want your guys to say at least one nice thing about the American Pharmacists Association when you click on the Comments Button and start lambasting the organization with the golden name.

            Remember that the mission of the APhA is both ambitious and weak at the same time for an organization that has PHARMACISTS in its name.  The name American PHARMACY Association works better for what the organization does.  Why the name change?

            The stated mission is:  Improving Medication Use.  Advancing Patient Care.  I’ll leave it to others to tell us if the APhA is living up to that mission.  For you others, how in hell can you have expectations from that mission.  I know, I know, it is the American PHARMACIST Association.  The APhA does not give a shit that you worked three 12 hour shifts back to back to back.  The APhA won’t even read your letter when you write and present the idea that patients are in danger when you do not get a rest period during a shift when you and 3 technicians put out 400 Rx.

            But, as far as the mission goes, they are spot perfect for me.  I have avoided anything APhA for 30 years.  For the last 5 years, right here, I have done nothing but snipe, make fun of and denigrate the American PHARMACISTS Association. 

            Last month, my company asked me to get re-certified as an immunization provider.   My first certification was in Washington State in 1998.  Not good for Texas, so I did the APhA’s program at no cost to me.  I got 20 hours of CE and was paid for the 8 hour class room.  It was spot perfect.  Certainly not a walk-over.  I had to go over the material carefully and the two exams required frequent reference to the written material.  As far as I am concerned, this program does Improve Medication Use and it does Advance Patient Care. 

            So, why do I expect more from the American PHARMACIST Association?  Because of the name.  The golden name.  They need to either live up to it or change it.  I do not see either happening any time soon. 

            The discussion took a quantum leap when the premier pharmacy news magazine published a brilliant article by David Stanley, R.Ph. (The Drug Monkey).

David entitled his column:  YOU TALKIN’ FOR ME? (Drug Topics, January, 2010).

The 3 full pages of Letters to the Editor that followed (Drug Topics, February, 2010) represent only a fraction that were sent to the editor.  All except one was like the letter from Myron Bryant, R.Ph, Tennessee.  “Hallelujah and amen to David Stanley.

Drug Topics is finally back on track.  The truth will set us free.”

            And the letter from Morris Lloyd, R.Ph., Kentucky.  “Your article was right on.  You stated all the reasons that I dropped my APhA membership and unless they get their act together, all pharmacists should do the same.”  That may be unfair, Morris, remember the mission of the American PHARMACISTS  Association.

            The last letter was an act of bravery.  It was written my Tom Menighan, BPharm MBA, Executive Vice President/CEO of the American Pharmacists Association.

            If you have not yet, you need to read all of this, especially students.  Look to the right.  You will find the link to Drug Topics under “A Section For Pharmacy Matters”

            To find David’s column, enter DAVID STANLEY where it asks for Key Word and click.  The column is #3 on the list.

            To find the Letters to the Editor, enter LETTERS DRUG TOPICS for Key Word.  The letters you want are #5 on the list.

            Semantics is an interesting pursuit.  If you name it right, you are half way there.  George W. Bush’s “Clear Skies Initiative” allowed more pollution than ever.

The American PHARMACIST Association has the name.  All pharmacy school students have got to think, “This is the organization for me. It will address every concern I might have in my career.  It will take initiatives that will protect me.”

            Oh yeah, Charley, that’s what I’m talkin’ about.   Yeah, sure, Yuck Yuck Yuck.

            Perhaps THE PHARMACY ALLIANCE needs to change the name to THE AMERICAN PHARMACISTS’ ALLIANCE.  It is the only organization with a mission of assuring that the JOB of working in a pharmacy includes DIGNITY, SELF-RESPECT & INTEGRITY.  So simple.  So vitally important.  www.thepharmacyalliance.com.  I have a pony in this race.

            In the end, the dignified thing to do.. the expression of integrity ..would be for the American PHARMACIST Association to CHANGE THE NAME so that thousands of young people, students with a long futures, who want dignity, self-respect and integrity on the job, will not put all their eggs in a basket full of holes.  

            I tried really hard to present a positive lean on the APhA.  How’d I do?  Help me out.  Jay Pee.

 There are times when I read what I write and then read your comments and then read personal e-mails from pharmacists and technicians and then catch a glimpse of Rush Limbaugh and Glenn Beck and think that we are all the same.  Don’t misjudge Jay Pee’s bleeding heart.  I’d rather be submerged to the neck in Jergen’s Lotion and have to pay attention to Keith Olbermann and Ed Schultz for 24 hours than listen to Rush Limbaugh or Glenn Beck for a half hour sitting naked in a hot tub with four high class Stowe, Vermont hookers who come down from Montreal.  Amazing women.  Attractive, classy babes.   I filled prescriptions for a couple of them.  That French accent gets them another $500.00 for the night, I’d bet.  That fact that I have been known to immerse myself in progressive talking heads and make fun of OxyContin Eating Limbaugh is the crux of our problem.

            We are like animals that eat their own young.  The problem is acute everywhere.  With the Internet, and the ability to get only what we are interested in, we do not get a balanced view.  I am not going to search out Limbaugh and those of you who like Beck are not going to click to MSNBC when Rachel Maddow takes over.  That is too bad for all of us.  We are limited.  Our intellectual scope becomes more and more narrow.  We are idiots.

            You can follow the dialogue here at www.JP or over at The Drug Monkey’s place.  You can visit The Angry Pharmacist or Sir/Lady Angriest himself/herself and you are basically going to get the same slant.  Pharmacists are fine fellows, highly educated and important in the medical care universe, but pharmacist has been done wrong. Galley Slaves.  Eric Durbin has an expressed goal of taking the high road in his blogs.  I’m interested in knowing how that has turned out.  What you usually get is a huge litany of whining about working conditions, employers, stupid patients, idiot prescribers, idiot bosses, stupid non-pharmacist managers.  Do I go on?

            We live in this pseudo-world of agreement where we never hear the other side.  I cannot recall anyone, ever presenting the reason why 12 hour shifts are necessary.  No one has ever defended the APhA here.  I have never read anything that defends the PBMs in the blogs.  I want these viewpoints expressed.  Some of you may think they are reasonable.  Dome on, dare to engage.  The comments would be entertaining to all of us.

            I do not think that I will chose to listen to Limbaugh or Beck, but I will read the Wall Street Journal.  As a balance to The New York Times. 

            As it is right now, you and I are the pigs in Animal Farm (Orwell).  We run this part of the cyber-world.  I don’t like it, but, if there was even a few rational answers to our whining presented, I’m thinking that it could be like The Lord of The Flies.  We would verbally kill these bastards, sitting around the camp fire.  We would dog-pile-on-the-rabbit. 

            All it would take is one strident voice, “Get the sunuvabitch”. We would kill the messenger.  You can do that on the Internet because it doesn’t feel real.

            Is that a good thing?  I think not, but that is where we are in the evolution of the JOB of working in a pharmacy.  When we can whine and bitch on a blog it feels like we are doing something about the predicament we find ourselves when we have earned 180 hours of paid vacation, but we can only take one week at a time and only in October or February.  Whining and bitching is NOT doing something.  Complaining as loud as we complain does absolutely nothing for us. 

            Do any of you have both the inclination and the courage to defend THE DARK SIDE?  I know that you company men/women are reading this.  Do you have the guts to say your piece?  You can be anonymous. 

            I’ll stop right there.  You know, my friends, we operate in a virtual Iran. By choice, we read only what we agree with and that is not a good intellectual way to go through life.

ABOUT THE PAGES UP ABOVE. 

Soon, I will take down all of the current pages and post ten brand new ones all on the same day.  With my habit of changing the pages or adding a new page every week or so, the average depth per visit is three pages. I’d like for the pages to do better.  My goal is to put better writing into the pages.  More compelling pieces.  I’ll still give you videos from YouTube, but one at a time.  What I want is for you to comment on the pages. That is the only way I can tell if you like them.  I will put up Guest pages if the writing is good.  I may even allow a recruiter if he/she is honest and has something to offer.  In the end, I want to know why you don’t comment on the PAGES. 

We should stop. I mean, totally, we should stop, know what I mean?

I am surprised and disappointed that no one has commented on this. Is this too racy? How about you guys with religious standards who shout, “No Soup For You” through the Drive Through telephone? I know that there are those among you who just sell it without a second thought. YOU CONSTITUTE A PROBLEM. If you cannot see the value to the patient (And to the profession) of properly counseling on EC, then, hell, you are, indeed, a highly paid TECHNCIAN. Come on, you guys, get your asses away from the Prescription Mill for 3 minutes. Make them come into the store. Jay Pee

All of us were young once and some of us are young right now.  I did not remember the significance of Saturday night until I worked my first two Sundays in ten years.  Young women and men “hook up” on Saturday nights and with their loins hot and their brains turned down; they get laid and forget to use a birth control method.

When I was a young man, all it took was a woman with no bra and her nipples pressing against the thin material of her blouse and I was ready to screw a tree.  I was new to California and I became very clear very fast that this was not an Ohio drug store.

The girls would walk down Aisle 9, the cough and cold on one side and the pain meds on the other side.  This was 1966.  The girls were still soft looking with curves.  I had never seen women like this before.  I would have been putty in their hands.

I worked two Sundays in a row recently.  Both days, the technician said, “There is someone at the drive through who wants “Plan B”.   Six times, both days.  It took me awhile to realize that the night before was Saturday night.

“Tell them to come into the store.”

I won’t sell “Plan B” at the drive through.  I have required many patients to come into the store for counseling on other drugs.  Think Prelone with a graduated dosage.  I feel uncomfortable blabbing loudly at the drive through and I want to make sure that they understand what I am telling them. 

This was Sunday morning.  The day after Saturday night.  There is not a lot I want to tell them, both boys and girls doing the purchasing.  Take with food.  Vomit in the first 2 hours and you have to buy more pills.  Vomit after 2 hours and you are okay.  Breast tenderness is probable.  Next period may be early or late. 

Every purchaser seems thankful for the information but what gets big grins is when I say, “You know better, don’t you.”

That’s when I hear about the craziness of horniness.

“Oh gawd, I don’t even like this guy.  I don’t know how it happened.”

“We were at her house.  The condoms were at my apartment.  I just couldn’t stop myself.”

We talk for awhile.  I end it by saying, “Take Grandpa Jim’s advice.  The condoms are on aisle 4.”

CVS is not going to like this. There is absolutely NO WAY that that quality of counseling could take place at the drive through.   This is personal counseling.  I am close to the girl.  I take her to the waiting area.  I can smell her perfume.  With me this close, she has to consider the Perfect Storm of Dumbness that occurred last night.

 We are face to face, eye to eye.  Her personal space is invaded.  She allows me in.   Think about this.  Not just with Plan B or Next Choice.  Counseling at the Drive Through is not appropriate with many opportunities.   Period.

I was shopping at the local Target when I came upon a booth for Income Tax Preparation.  The guy was my age so I stopped and said, “Hello.  How’s business.”  He charged $35.00 to prepare a 1040EZ and some people say that pharmacists are robbers.

He was a retired Tax Attorney.  “I like people,” he said, “And my wife died a few months ago and I really needed to get out of the house.”

“Please accept my condolences.  Losing a spouse has to be a horrible experience.”

“Especially the way she died,” he said and his face darkened.  “She died from Xanax and Lithium.”  His whole body stiffened and his mouth hardened.

“Do you think the Xanax and Lithium were the cause of her death?”

“Of course.  There was nothing else.  I woke up one morning, rolled over to kiss her and her body was cold and stiff and hard.”  He gave me a look.  “The drugs killed my wife.”

I took a chance.  We did not have to be friends.  This guy did not have to like me.  “Did she overdose?”

“Hell NO!”  Any chance of friendship was forever gone.

Lithium, of course, can kill.

If you do a little search in the package insert for Xanax you will find the the LD50 for 6 week old rats is so high that it is reasonable to speculate that an adult human being could not get that many pills down, even if they hoarded their prescriptions for year.  Adding a few cocktails is a game changer.  I wondered if her pharmacist had gotten eye contact and had warned her about Martinis + Xanax.

“Did your wife drink?”  I cringed when I asked the question.  This was in Target.  I was not behind them counter.  I was a guy wearing khakis, a T-shirt and sandals (The uniform for the off duty professional in Galveston.  An island, just south of Texas) This question did not please the Tax Man. 

He crossed his arms over his chest.  His mouth moved circularly like a person suffering from extrapyramidal effects. 

I stepped back.  I nodded, said, “Have a good day” and split.

I can’t help myself.  That is what a pharmacist like me does.  My question was appropriate because I wanted to know.  I could use the information as anecdotal evidence when I counseled a drinking patient on benzos.

Here is an anecdote.  A delightful young woman in Pacheco, California was unlucky in love.  She had been used and was discarded.  She hoarded her Valium and took all of them one Saturday night.  She told me about 120 five mg tabs.

She had one terrific sleep and woke up alive.  After that event, she was in great shape psychologically.   She was happy to be alive.  Just the process of actually doing what she thought would end her life, ended her pain. 

I never warned her about Valium + Alcohol.  I worried that the information could be dangerous to her.  I have wondered, over the years, if that was the correct choice.

In this case, there is no right or wrong, I think.

I work with a guy who started in this “business” about 20 years after my start as an RPh.  That was August of 1964.  He was talking about the differences.  The first pharmacy computer system he worked with was an on-line prescription model.  If the computer in a distant city went down, every client went down.  It happened for hours and he was dead in the water.  There were times when catching up took days.

The small chain drug store company he worked for had rules.

No one has to wait, even if the computer is down. 

Yeah, Yuck Yuck Yuck.  The guy who came up with this rule was a grocery store man.

You bring the typewriter out of the closet and get the work done.

You Calculate the price, including copays, with the calculator.

As soon as the computer is back up, you enter all of the prescriptions you filled the same day. 

Hardy Har Har Har on that one.

I told him a bit of my story.  We didn’t even have computers in the 1960s.  Thrifty Drug Stores were open 9:00 AM to 10:00 PM.  I worked plenty 13 hour shifts even though we had two and a half pharmacists.  There were no gates.  If the store was open, a pharmacist had to be on duty.  There were no techs.  Only Registered Pharmacists were allowed in the pharmacy.

He asked me, “How did you get all of the work done without technicians.”  His eyes got a little wider.  We all know what it is like when the last technician leaves for the day and the pharmacist is all alone.

“A great day was 100 prescriptions,” I offered.  “There were no PBMs.  Every single prescription was cash or check.  There was no such thing as a credit card until a couple years later when the “BankAmericard” came out.

He looked dumfounded.   “A hundred was a good day?”

The USA had a population of less than 150 million.   There weren’t that many high blood pressure or heart patients.  I can’t remember a Parkinson patient. Trapped housewives took Librium.  There was no such thing as depression.”

“Why?  Were they healthier then?”

“Far from it, my friend.  They died.  There were no Statins, no ACE Inhibitors.  The cutting edge drug for hypertension was SerApEs.  Ciba’s Serpasil Apresoline Esidrix combo.  In the 60s, kids died from Rotovirus.  We sold ten prescriptions a day for Lomotil. 

We don’t sell ten a month in 2010.”

“So, they just died?”

“They just died.”

The CEO of Phuck the Pharmacist PBM

“House” the award-winning FOX TV drama is compelling TV. They get the drugs right so often that it is satisfying. You can forgive them when they get the drugs wrong. This is for all “Decision Makers” in Retail Pharmacy. From the Independent to the RPh CEO of a 7000 store chain.

I enjoy “House”. I especially enjoyed it when Dr. Lisa Cuddy, the hospital administrator stared down the biggest BIG MEDICAL INSURANCE company in New Jersey and won.

It brings up a provocative question about you, WAG, CVS, Kroger, Safeway, Wal-Mart and every other pharmacy company’s spine. It’s relative toughness, its probable softness. Lisa Cuddy’s spine is tested. It turned out to be steel. Big Insurance needed the contract more than she did. Cuddy was willing to lose her job.

This is great TV, you guys. Your loins will be affected. You will get a terrific vicarious charge. First, Cuddy is in danger. Then, it looks hopeless, then… she wins.

It will make you wonder about how the PBMs got such control. I am going to attempt to tell you.

About 20 years ago, some bright ass guy sitting around the table at one of the PBMs put up her hand and said, “Let’s lower the AWP 10% and reduce the fee by 10 cents.

She got laughed down, but, the Chairman said, “What the hell, Lillian, let’s throw it at them and see if it sticks. Hardy har, yuck, youck.”
At the meeting six months later, Lillian stood up, beaming, and reported, “They went for it. 90% of the pharmacies returned the contracts signed, without a complaint.”

“What assholes. Can you believe it?” The Chairman popped the cork on a bottle of Cristal. He passed out the big cigars. He was gleeful when he said, “Next year we’ll go for 15% and 25 cents.”

Well, you know what happened. I know that individual pharmacists are institutionalized, but I had no idea that EVERYBODY in this industry are like lemmings. Walgreens is taking a stand with the Washington State Medicaid Program. (Drug Topics, February 2010, Page 21) 64 Walgreens stores are pulling out because of intolerable cutbacks. What’s wrong with the rest of the decision makers? This would be an easy one to solve if the decision-makers started acting in the best interests of their businesses.

I will give you odds that, in the end, the recipients rule. You take away Mildred’s ability to get her Rxs on her insurance at the drug store 10 minutes from her house and she will bitch to her benefits coordinator. Mildred’s company pays the premiums and the check writers rule. When the companies threaten to move their coverage, there can be a sea change. The tide will flow in your favor.

INSTITUTIONALIZED. Like Prisoners. Even the decision-makers are “Galley Slaves”, Paul.

You guys who own the stores that still depend on selling traditional prescriptions for a living may as well take a stand. Sudden death is far better than a death from a thousand tiny cuts.

Here is how you can see the “HOUSE” episode. Google Hulu. When you get to the Hulu home page, enter House in the little box and enter.
Click on Season Six, Episode 13 Titled “5 to 9”

Don’t do this if you are a chicken. It may make you ashamed of your own flexible spine.