Ben Goldacre is a skeptic after me own heart

 Goldacre is a physician and science writer.  The full title of the book:  “Bad Science: Quacks, Hacks and Big Pharma Flacks”.  Of course, the flacks got my interest, but it is amazing how gullible people are and how much money Big Pharma pouts into products that they know are overstated, failures or downright dangerous.

You can check out Goldacre at badscience.net or follow him on Twitter:  Twitter/bengoldacre.

The author describes his book as an “epedemiology textbook” made easy with jokes and moron-baiting.  The books sets up some popular rremedies like detoification foot baths and ear candles, alternate therapies, scientific-sounding face creams, nutritionists, and brain-expanding exercises for children as though they were pinatas, slapping at them until their credibility falls out.

For pharmacists, however, the best Goldacre target:  Clinical trials designed to play up the benefits of prescription drugs and PLAY DOWN the side effects.

Goldacre reminds us to lok for hard evidence and not rely on product marketing that involves cherry-picking statistics.

“Why do smnart people believe stupid things?” Dr. Goldacre asks.  “I thought by mocking people who are wrong, it might be a way of showing how to do medical science correctly.”

Watch out for the good looking ones.  This woman is drop dead gorgeous, strong and buffed up from hours in the gym.

You guys will like this story.

The technician said, “Jim, Danisa Kavikova is at the drive-through.   Can I sell her the prescription for birth control?”

“No, you know better.”  I walked to the window and picked up the phone.  “Danisa, come inside.”

“But I have class.”

“Come inside.”  I walked away from the window.

Five minutes later, she was at the counter.  I went out front and indicated that I wanted her to follow me.  We went to a corner near the cosmetic department.

“I did you a favor Danisa.  I advanced you eight Concerta from your own prescription which was filled and ready until your insurance was straightened out.”

“But, I have the paper…………”

“Danisa, be quiet.  You lied about it to Dan and he gave you the eight extra tablets.”

“But, I have the paper……”

“Danisa, the technician that was on duty on Sunday was there with Dan and told him that you were lying.  She is also right here.”  I looked to my left and the technician was listening to us.  “She is a witness to all three transactions, so stop lying.”

“Why are you attacking me?”

“Oh shit, because you deserve it.  Are you a medical student?”

“Physician’s Assistant course.”

“You have an interesting accent.  What is your immigration status?”

That got her.  Her eyes widened.  She started to breathe quickly.  I was silent.  She would not answer my question.

“Russian,” I asked.

“Ukraine.”

“You either return the eight tablets or I have no choice but to report this to the Drug Enforcement Agency.”

“For eight tablets?”

“Eight or eighty or eight hundred or eight thousand.  It doesn’t matter to the Feds.  It is theft of a Schedule II Controlled substance.”

“Well I… well… I have the paper…”

“What the fuck paper are you talking about?”

She stared at me and hyper-ventilated.

“I do not want to have to go into the Houston FBI office and give a deposition and I sure as hell know that you don’t want to go in with me to sit for a polygraph”

“Polygraph?”

“Lie detector test.”

“Okay, okay, okay, I’ll bring back the eight tablets.  Can I have my birth control pills now?”

“Not until I get the eight tablets.”  I walked away from her.

Two days later, she presented a new Rx for Concerta.  “Can you take the eight tablets out of this bottle?”  Her hands were shaking.

“Yes, I can.”  I reached out and took her hand.  “Relax, Danisa.  It is over.  Just remember, this is America.  I know that cheating is a way of life for the majority of people in much of the world, but not here.  Cheaters, when caught here, pay a big price.  I hope you understand that now.

The cheaters that I want to see nailed are the executives of CVS-Caremark.  Stay tuned.

Note: Any loaning I do in the future will require the recipient to sign a receipt. From the comments, I need to clarify.  She had a legal Rx.  I filled the Rx and, being a soft touch, I gave her eight tablets from HER FILLED RX.  She lied to the next pharmacist and ended up with a total of 38 tabs.  I’m not clear why Dan fell for her lie when the tech told him that she watched me give her the tabs and that this Ukrainian beauty was lying.  

Peon sent me the following article from Pharmacy Times. Before you read it, let’s cut the crap and acknowledge some truths.

Lately, on these pages, pharmacists have been talking about not being in the loop and not being qualified to prescribe because they do not have access to the patient’s medical records.

Lately, pharmacists have said that they are not privy to the diagnosis.

You are talking about an ideal world if you believe that every prescriber is a competent diagnostician and therapist.

There are plenty of “C” students who have been working as doctors for two decades and are hopelessly out of the loop when you are talking drugs.

There are plenty of doctors who don’t give a shit.  They enjoy the golf games at the country club and Thursdays on their sailboat.

There are plenty of doctors who simply guess.  My personal experience has soured me.  I have the late effects of polio.  This is a degenerative neurological condition that every polio patient will get if he/she lives long enough.

I have had only two doctors know as much about it as I do.  The first one who diagnosed me in 1987 and the last, the guy who conducted the electromyogram.  Every other doctor in between just blew smoke.  That is irresponsible.  I was dumb enough to take their advice.

So, as you read this article, let’s agree that not every doctor is competent.  Right at this moment, you can name doctors that you would not allow your loved ones to see for a medical issue.  Period.

You know doctors who paint by the numbers.  How can it be possible that so many of their patients need the same list of drugs?

I am leading with this because you know and I know that you are under-utilized.  Doctors can be wrong and are wrong often.  This is not 1975 when the doctor could not make mistakes.

This is not an ideal world, but pharmacists can help.

This elderly woman gets Combivent and Xopenex.  She is huffing and puffing, so I ask her if she has had her flu shot yet.

“Oh no, I don’t get flu shots.”

“Why not, maam.  You have COPD.  You are an older woman.  A case of the flu could kill you.”

She gave me a look.  “The flu shot could kill me.”  By now, she was so worked up in being righteous that she was practically gagging.  “The last time I got a shot, I got so sick that… well I really got sick with diarrhea.”

“Maam, the flu is a respiratory illness that could make your COPD worse.  It is not diarrhea.  You need to get a flu shot.”

“My doctor told me not to get the flu shot.”

“Statistically, eight people in Galveston will die from the flu this winter.  Most of them elderly.”

She wasn’t listening.  “Doctor Traynor told me not to get the flu shot.”

“Is Doctor Traynor your doctor?  He isn’t the doctor who prescribed your puffers.”

“He’s retired and he told me never to get the flu shot because it could make me sick.”

“Doctor Traynor is wrong, maam.  Dead wrong.  The flu shot is made from dead viruses.   It cannot make anybody sick.”  I was unlike Jay Pee.  This is the kind of message that I am usually too strong with.  I sensed vulnerability so I said it lightly with a smile.

“I got sick the last time.”

“That was coincidental.  Blaming the flu shot is like blaming lunch if you get into a car wreck on the way home.?

“Doctor Traynor said..”

Now I was like Jay Pee.  “.. Doctor Traynor is wrong!  It is irresponsible for a physician to give such bad advice.”

Later I get a call and it is Doctor Traynor.  He had to be old.  I probably did him a favor.  Get his back up a little.

“Why did you tell Mrs. Sims that I was wrong?”

“Because you are wrong, Doctor.”

“You told her that I am irresponsible.  Why?”

“Any physician who gives the kind of advice about the flu shot that she says you gave her IS irresponsible.”

“What did she say that I told her.”

So, I told him and gave him a quick wrap-up about the flu shot.”

“Oh,” he said, “they must have changed it then because it did make people sick twenty years ago.”

I didn’t agree, but, with silence, I gave him that.  “Perhaps you could call Mrs. Sims and tell her that she needs to get the modern shot.  She has COPD, Doctor.  She can’t afford to get the flu.”

“You mean the respiratory flu?”

I wanted to be smart and ask what other kind is there, but I just answered, “Yes, the respiratory flu.”

He said that he’d call Mrs. Sims.   We will see.

Our job is hard enough.  We do not need to put up with idiots no matter what their title is.  The days of deferring to a “C” student who managed to get his state license are over.  We certainly do not need to give a guy like Dr. Traynor even one inch.  If she is wrong, she is wrong.

Thank you with all my heart to those of you who expressed your care and concern. Betty Jo sent her love and Olga said to assert our grandparents’ rights. Brooksie is a citizen of the USA. I guess that makes a difference. Olga takes no prisoners. She suggested that we get custody.
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Speaking of taking no prisoners. The Federal Trade Commission is investigating CVS-Caremark. You and I know that the merger violates anti-trust laws. You and I can do squat.
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The FEDS, however, can bury CVS-Caremark. CVS-Caremark is the Roger Clemens of our industry. They operate like teenagers on dope. They are huge and that makes them bullet-proof, they think.
All it takes is one lie under oath and The Party is Over. Turn out the lights.
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Martin Grass is the ex CEO of Rite-Aid. His father is the founder of Rite-Aid. Martin Grass is doing ten years hard time in a.medium security prison in Carolina. Essentially, Grass was nailed for lying to the FEDS. What about being under oath do they not understand
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Can you hear Tom Ryan, CEO of CVS-Caremark? “No, your honor. At no time did CVS intend to restrict trade to favor our company.”
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Send a fax to Martin Grass. You gotta new bitch comin’.

I am taking a glass of wine down here to say Goodbye to the day. Jay Pee.

The Gold Standard Winner for Chicken-Shit

The Gold Medal Winner is CVS-Caremark

CVS has readily disclosed that the company is being investigated by the Federal Trade Commission and more than 20 states.

No shit, Sherlock.

The $26 billion merger of CVS and Caremark violates antitrust laws, in the opinion of many astute legal minds and even more astute drug store industry minds.

This merger could not happen now.  It was whisked on through during the industry ass-kissing GW Bush administration.  Unfortunately, the Supreme Court as it is now constituted would probably support CVS-Caremark.

(For those of you independent owners who are staunch conservatives, you are idiots.  You are poverty level little guys to the conservative powers.  They do not want you to win.  They are dedicated to corporations.)

Do you think that Walgreens could have faced CVS-Caremark down in that recent cage fight unless WAG had evidence of CVS-Caremark’s culpability?

The emperor has no clothes and the emperor hated it when WAG pointed and said, “You have a wart on the end of your nose and we are going to nail your ass unless you get fair and sign reasonable contracts.”

I personally hope that the new Wag/CVS-Caremark heavily favor WAG and that every other company can duplicate them.

CVS-Caremark’s position in tenuous.  They are on a tightrope and they know it.  Any shift in the wind can knock them off.  I am not a mean person, but CVS deserves to fall as far as Rite-Aid.  But that could harm our industry.  It might not be good for our industry to have companies that own almost 12,000 stores be failing and disgraced companies.

(If you sold one share of Rite-Aid, you couldn’t even get a bottle of Corona Beer during Happy Hour at Salsa’s on the seawall)

There is a little butterfly flutter building in Texas that could turn into a Category Six for the 18^th largest corporation in the United States.  A group of Texas pharmacies have filed suit accusing the nation’s largest pharmacy healthcare provider of violating racketeering and privacy laws.

This is not a minor inconvenience for CVS-Caremark since the Texas group quotes extensively from CVS plans, presentations and even a job posting for a data analyst or data recovery for mac specialist.  Is this enough?  Is it a smoking gun?

Careful if you own CVS stock.  It’s around $31.00 today.  One little hint of anti-trust action by the FTC and the mutuals will be hauling ass.

One thing about the Feds.  Violate the law is one thing, but to continue to act like a teenager on marijuana is another.  CVS is not bullet-proof.  Embarrass the Feds and they will show you how small your 19^th biggest corporation really is.

CVS-Caremark was also recently asked to provide a confidential briefing on its merger to a Senate antitrust subcommittee, reported by Bloomberg news.  If I was Tom Ryan I’d be instituting my golden parachute and get my ass oudda there.

The Texas lawsuit states that the practice of CVS-Caremark in violating the privacy of patients and unfairly competing is well-documented.  The lawsuit accuses CVS-Caremark of gaining too much control over patient information, including files from independent pharmacies that have to hand over patient information for insurance disputes.

The Texas lawsuit shows CVS plans as detailed in a slide from a presentation by Troy Brennan (Bullet-proof, Troy?), the company’s chief medical officer.  The slide shows how the company plans to develop a “Consumer Engagement Engine” with “A comprehensive view of the patient.”  The computer screen would show her name, demographics, drug history, prescribers, health behavior (including suboptimal adherence) and communication preferences.”

CVS-Caremark had nearly $100 billion in sales in 2009.

We all know about the chicken-shit behavior.  Sending letters to people with CVS-Caremark cards stating that they had to go to a CVS store if they wanted a 90 day supply.  WRONG.  Promising Medicare Part D one price and charging them a bigger price.  They admitted the ERROR, but, of course, they will keep the money.

CVS-Caremark is a dirt bag company.  They deserve to be in the gutter with Rite-Aid (Stock Price- 91 cents a share at 4:35 PM CDT 10-4-2010)

But what does it say about our industry if we have only one of the huge drug store companies on the high road?  What does it say about us if Wal-Mart is a beacon of ethical and fair pharmacy business practices?  What does it say about us if grocery store pharmacies are more ethical than 12,000 drug stores?

If you and I flaunted the law like CVS-Caremark has, we’d be hiding in the corner every night when we heard Bruno screaming, “Where’s my bitch?”

Rite-Aid went down into the sleaze, screwed the goose, embarrassed the Feds and CEO Martin Grass, the son of the company’s founder, is serving ten years in medium-security Butner Federal Detention Complex in North Carolina.

Ten frikkin’ years.  Tom Ryan, take the money and run.

CVS-Caremark is the clear winner of the Gold Medal in Jay Pee’s Gold Standard of Chicken-Shit Awards.

This was the cocktail party that I wrote about in Chapter 13 of JP’S 20 SIMPLE RULES.  The woman in the picture was Millie Blake.  I am the guy with the black tie.  The other man was Bob Burt, the Pastor at my church and my drinking buddy.  I learned a huge lesson that day.  I had no courage.  I am still ashamed of what I did.

I have been going through old pictures lately.

 

A woman walked up to me.  She was skeletal.  Her flat blonde hair looked uncombed.  Her smile was luminous.  She leaned toward me and kissed me on the cheek.  I knew who she was, but I was a coward.

 

“…Recognize me?”I cringed with embarrassment.  We talked for awhile and then she took my hand and put it on her head.  I felt the tumors.  I pulled my hand away quickly.  I must have frowned.  I stepped back.  I was so young.

 

A shadow darkened Millie’s face.  “It’s just my cancer, Jimmy.”  She studied me.  “It’s not catchy.  Her eyes implored me to be what she wanted.  “You are still my Jimmy and now you are a pharmacist.   Why are you so afraid?:

“Do I know you?”  I asked, but I was faking it.  I knew her too well.  Her perfume and closeness affected me.   Her warmth and the Lily of the Valley scent of “Diorissimo”. 

 

 I could have fallen in love with that smile all over again, very easily.

 

I stammered, “I didn’t..”  Her perfume was so familiar.  Lily of the Valley.  “Diorissimo”.

 

“I.. I heard you had cancer.”

 

“Not had, Jimmy.  I have cancer.”  She managed a smile, stepped very close, looked up and kissed me wetly, full on the lips.  It was a long kiss and I felt her tears on my cheek.  That is the way it had always been with us.  Stolen kisses,  embraces in the hall.  She was five years older with two children and a high school principal husband.  We respected that.  I love her memory to this day.

 

I never saw Millie again and I have never been able to forgive myself for being such an insensitive lout.  I actually washed my hands.  I felt contaminated from touching her head.

 

I learned a difficult lesson very early.  They are still alive.  I became at ease with terminal patients.  I have visited them in their homes.  I have asked the questions that they want to answer, Are you afraid?  Does it hurt?  Heaven?