MPSA

Remember, the camera adds 10 pounds....

2008-12-13T09:12:00.002-06:00

First off, Stuart Speedie is Dean Speedie's husband, and is a researcher in health information technology. He's also quoted in this article on telemedicine. This is going to be a short post-but I just want to make one connection that you likely have made already-how could this affect pharmacy? A lot of pharmacist are consultants to nursing homes and review their charts once a month. Well, what if they could do it remotely and talk to patients through these means? Same with MTM-do people have to be in the same room in order to deliver pharmaceutical care? I guess we'll see where this change in compensation leads....

Ethical stuff

2008-12-04T07:49:00.004-06:00

First, for dramatic interlude, listen to this song in the background while reading the next two posts. Just open it up in another window and enjoy. That's right, even though no one is looking at this, I'm demanding my own background music. I guess my ego knows no bounds....

Awhile back I threw out that the WSJ, and specifically the WSJ blog, were must reads for health news. Current and up-to-date reporting, good insight, you know, that stuff. And, of course Pharmalot is great for pharma related news too. Well, the New York Times is making a run at them. Last week they had a great piece on research being done on real patients, with real problems. Ever look at a journal article and check out the exclusion criteria? I'm pretty sure I'd be excluded for stepping on a nail as a kid. You would be excluded (yes, you!) for reading this blog (read this) But when used in real life patients, you can't exactly exclude everyone from using your drug. You'll miss out on market share. But then, how would a drug become approved-so many complications/adverse events would show up in the study it'd be laughed at. Now you see why I labeled this "Ethical Stuff."

Well, the New York Times wowed me yesterday with this article looking at the cost of a life. In the time of serious calls for health care reform and complaints of rising health care costs, you have to ask: At what point does it stop? At what point do payors, and possibly, if we go to a single-payor system, does the government, say that it is too much for a drug. For a great analysis, check out the Pharmalot blog, and read the comments, particularly from "Michael" on December 3rd at 9:39am. Obviously, he's an insider for Pharma, but still, it's a strong point.

Things to consider as we get ready for change. Also, be sure to respond to the APhA Call to Action to actually participate in health care reform. If pharmacists aren't at the table, pharmacists won't have a say. It's that simple.

'CCO giving pharmacy some love

2008-11-19T22:51:00.002-06:00

Here's the link to the WCCO discussion about decreasing med costs. They mention the $4 generics and prescription assistance plans, but they also throw a shout out to MTM. If only threw out the phrase "The most expensive drug is the one taken incorrectly" they might have helped us out. Oh, and here's the link to the blog discussed as well. Hopefully patients are willing to pay for the money saved....

Why are Obama's cabinets so important?

2008-11-19T22:01:00.003-06:00

I mean, really. When my parent's got new cabinets, no one cares. When I do, again: No media attention. But all of a sudden, you're elected Pres-elect, and everyone cares about your kitchen...wait, what? Oh...boy, is my face red.

So, this is kind of huge. Well, maybe not huge, but it's going to have an effect on pharmacy. How? Well, I don't know. Sorry. But, Daschle's reportedly been angling for this for awhile. He supported the failed Hilary Health Care plan from the 90's (first years may not remember that, so here's some info on it) and is up for health care changes. Include the fact that meds take a huge chunk of overall health care (according to this vid) and you can expect some changes to occur in...oh...say...the next four to eight years.

Why tell the real news when the fake news is so much funnier

2008-11-15T22:30:00.003-06:00

I go to Comedy Central for news television, and I'm ok with that. I mean-who wouldn't?

Now, that's just plain good stuff. Plus, he hit the news right on the head. Let's run through the highlights.

I'll try and run through the topics he discusses in later posts, but I'll let you enjoy the video for right now.

Cuz I want you back for good...

2008-11-15T22:21:00.002-06:00

So, no one read this before, and likely no one will read this now. But you know what, I had a lot of fun writing it last year. So guess what, the blog is back! (Dramatic interlude for cheers and adulation. Shout out to Barack for showing me how to be humbly be showered with praise.)

Why is the blog back? Because there is just too much happening out in the world of pharmacy and health care to not at least make some kind of commentary on it. Sure, you could go to news sites and read the actual journals, but what fun would that be? Here you get few if any pictures, poor wit and sarcasm, and really no value added to the links I post. But hey, if you visit, it makes me feel good. Enjoy the updates.

Pharmacist's in Primary Care?

2008-04-19T23:56:00.002-05:00

The decrease in the number of physicians that pursue primary care has been noted over the past few years. The impact of this has contributed to increasing health care costs, and and a decrease in patients seeking primary and preventative care. This dearth of primary care physicians essentially created the market for nursing practitioners and physician assistants. However, this has still not solved the problem.

So, could pharmacists help out? We know that we are trained in disease management-particularly those that are often controlled primarily by medication therapy-diabetes, anti-coagulation, asthma, heart failure....ummm...there's probably more but I read too good. Well, the good folks at JAMA thought they would take a look at what pharmacists can do in the CHF. They have a spin-off mag called the Archives of Internal Medicine. It's pretty good, no People magazine or anything, but I like it.

Anyways, here's the article that they printed in Internal Medicine. I heard about it, where else, but on the Wall Street Journal Blog. Check out the links in the article too-they talk about the decrease in utilization of primary care and increase in specialty reimbursement mentioned above. They also discuss the 10 City Challenge sponsored by the APhA Foundation.

Short rant here: Stupid WSJ also is now making you pay for their Health page. At the least, they still give you access to their blog. But come on, Rupert Murdoch (who recently purchased the WSJ from the Hathaways) let me have access to the WSJ!!! I'm looking for some kind of online petition to make it all free, but I haven't found it yet. Let me know if you do, please.

Will drug companies write my papers?

2008-04-16T17:42:00.003-05:00

No, really-will they. Cuz that'd be sweet. Now why do I say drug companies instead of, oh, English Majors? Well, according to JAMA it seems that they are more than willing to write them for academia studying their drugs. CNN has the shortened version of this and some discussion on it. One journal official who looked into it said: "The manipulation is just disgusting. I just didn't realize the extent." Merck counters that 5 of the 6 authors were involved in the Vioxx case against Merck. Slight bias. Great article. Less filling.

Students stepping up...and more

2008-04-09T23:15:00.002-05:00

First off: Thanks to Kassy Bartelme and Colleen Flaherty for these next articles. Also, they tipped me off to Pharmacy Practice News. There are two things in life that make me happy: Spring and new pharmacy related news websites. I should probably say Laura too, but she doesn't read this anyways, so whatever.

Ok, back to real news. Medication Reconciliation is one of the goals within JCAHO. Goal 8 if you really want to know. If you work in a hospital, you've likely heard of "Med Rec" and 1) know it's important 2) know it's difficult to get accurate and 3) likely know that pharmacy isn't always involved. Last year at APhA2007, APhA-ASP brought this up and wanted to make it a priority for pharmacists and student pharmacist to the be the health care practitioner that provides this care.

Well, it looks like students CAN make a difference. Proof? Here. By the way, you have register with Pharmacy Practice News, but, ummm....we're entering pharmacy practice, so why not learn about the news within pharmacy practice. Plus, it's free.

Ok, lots of comments could be made on this. Let's do a pro/con debate. Against myself. Or for myself. I get confused. I'd go on Zyprexa, but I might get diabetes.

Pro: Students are learning about med rec. They are engaging patients in the role of a pharmacist, and are showing patients that we can do more than dispense. Patient outcomes are improving.

Con: Students shouldn't be used to do work pharmacists should be using. Hospitals should find a better way to do med rec. Interns should also be trained to do this (who are being paid) not students (who are paying)

Comment below-you can do that you know.

My greatest fear...

2008-04-07T22:11:00.002-05:00

I always knew this blog was a bad idea....

What happens in Vegas, stays in Vegas

2008-04-07T21:07:00.003-05:00

Ok, this has no connection at all to current events, in fact, it's probably from before many of you were born, but I'm going to post it anyways.

For Outcomes, one of our drug info questions dealt with the use of Cialis and nitrates. Through my research into the subject-I ran across this article on ED. Read the first paragraph in Editorial Comment 1. My only thought is, I guess urologists must be pretty used to displays like this.

Also, here's an article on Cookie Monster. Hey, I'm just trying to liven this place up. IS ANYONE OUT THERE!!!???

Pick your vices wisely

2008-04-04T00:05:00.005-05:00

So...in college, we called this idea the buffalo effect, and it pretty much follows evolution: The weak brain cells die, and the strong survived. Yeah, turns out we were wrong back then, according to this article.

But, there is hope for using daily diuretics. Though alcohol is bad, caffeine might be good. According to this article, caffeine was neuroprotective. Well, in rabbits, no testing in humans yet. But whatever-I likes me my macchiatto.

Ziagen and Videx raise heart risk

2008-04-02T14:26:00.002-05:00

A study in the Lancet found that the use of Ziagen (abacavir) and Videx (didanosine) raised heart risk. During the anti-viral section in Pharmacotherapy IV, some discusiong alluded to this: As people with HIV and AIDS live longer, the complications associated with long-term drug therapy will be a more significant risk than their actual AIDS. I'm obviously not an AIDS expert (no comment on my grade for the module...) but I think there will be a lot more information coming out on the issues of long-term AIDS therapy.

Just as a reminder, or to let you know for the first time, abacavir was developed right here at the University of Minnesota by Dr. Robert Vince. That's pretty cool.

Residency Talk

2008-04-02T00:12:00.003-05:00

For those that attended APhA2008 or have heard other talk of this, one of the hottest topics within pharmacy is the expectation that by 2020, all pharmacists who wish to enter into patient care will have completed a one-year residency. This is a controversial topic for many reasons, not the least of which is whether or not there are enough residencies (commentary on that topic here) There are numerous articles discussing this-and I suggest you keep your eyes open for further discussion on it. For background, try googling "JCPP Future Vision of Pharmacy." I think this will lead you to many easily accessible discussion of what the future will hopefully be. Here's a copy of the original statement as well.

What reminded me of all of this was an article discussing nurses pushing for a doctorate in nursing to act as primary-care practitioners. I won't delve too much into this article-but one line caught my attention: By 2015, the American Association of Colleges of Nursing aims to make the doctoral degree the standard for all new advanced practice nurses, including nurse practitioners. Seeing all of the discussion that pharmacy is having, I felt this was a bold statement and prediction for them to make. Think of the impact that this would have on nursing education, and how closely this likely mimics the discussions that pharmacy is having right now.

I won't belabor this too much more, and I don't know how I feel on either way of advocating for residencies or not. But when we discuss, as a profession, what we want our future to look like, I think we need to remember that we need to find the best way for us to be the best medication experts for patients available and decide how we are going to get there, or other professions will decide for us.

Minnesota = Kind of a big deal

2008-03-27T08:30:00.003-05:00

For those that went to APhA2008, you received the most recent copy of JAPhA, you may have seen this. You remember MTM? Well, apparently, it saves patients a lot of money on their medical expenses. Now, I'm no genius, but I did stay at a Holiday Inn Express last night. So I think that people may pay attention to the cost savings that can occur with MTM, and will help for it to be reimbursed. Good work to the good folks at Fairview Hospitals and Clinics and the good ol' University of Minnesota College of Pharmacy. I also think it may fall in line with the goals of Project Destiny, a collaboration between APhA, NACDS and NCPA.

Also, just a reminder of other cost savings programs, here's some info on the Asheville Project, which most of you have likely heard of by now.

TB Talk

2008-03-25T15:30:00.002-05:00

I may or may not listen to NPR constantly. I won't comment on either side. But, one time, I happened upon a story that I found very interesting: On tuberculosis in Bangladesh. Two important things to note before going to the NPR piece: 1) Drug resistance to TB is a problem worldwide. The WHO checked this out recently, and I mentioned it a few weeks ago.
2) Bangladesh is a poor country and one of the most population-dense countries in the world. Bangladesh also just suffered a horrible hurricane last November.

So, judging by those two facts, one might say Bangladesh would have a horrible rate of MDR-TB. Meh, turns out-no. How'd they do it? Well, take 5 min, and listen to the NPR piece.

Some interesting points, and I'll just throw out two words: Alligned incentives. It's amazing what can be accomplished if an entire population believes in one goal.

Heparin Follow-up

2008-03-09T13:03:00.002-05:00

Seriously-how many times will heparin come up in the news? Just seems strange to me. The recall of Baxter's heparin supply (oh, and Baxter supplies about half the heparin to the US) caused some ruffles, especially if you work on a hospital. Or, if you work in Germany. Also, they figured out what was in the heparin that caused nearly a thousand allergic reactions, and several deaths. Here's an article that has links to previous articles if you want more information about the recall.

So, now for the rest of the story. As this editorial from the Washington Post points out-there are some major problems in the drug approval and investigation process. According to this editorial-80% of active drugs are made outside of the US, and not all of those plants are inspected.

Now back to the heparin-Here's a little info on where some of the heparin in our supply comes from. Be sure to click on the slideshow to see more pics-as well as pics from a factory that is quite a bit cleaner and more advanced.

Follow up to Emily Jerry and Techs

2008-03-05T22:04:00.003-06:00

We first heard the tragic tale of Emily Jerry back in October. A reminder: Due to a mistake with her chemo drug that was not caught by the pharmacist, Emily passed away. The family, after investigating, filed manslaughter charges against the pharmacist. The family are also proponents of a law in Ohio called Emily's Law. The purpose of this bill is to require pharmacy technicians to be trained, tested and certified, which is also what MPhA is promoting. They are also very prominent in a group called FLAAME-Families Launching Action Against Medication Errors.

One of the supporters of FLAAME is Dr. J. Lyle Bootman, who has won the Remington this year.

Anti-depressant's getting you down?

2008-03-02T23:41:00.003-06:00

Well, according to this article, they aren't helping you feel better. Well, a bit of an overstatement: They found, through evaluating 50 trials on paroxetine, sertraline, venlafaxine and fluoxetine, that there was not much improvement found in patients who were put on meds versus those that were only put on a placebo pill. For (the few) third-years in Ethics on Thursday, I guess docs may be prescribing placebos even when they don't realize it. Here's the article on the always reliable Pharmalot as well as the article from the University of Hull where the study was conducted. Also, the UK (where this study originated) has decided to pour more money into training therapists to help out those that are depressed.

It should be noted that there was a difference noted in severely depressed patients, and that anti-depressants did work in quite a bit of the population, just not in an appreciable amount more than in placebo-so if it works for you or your patients-keep 'em on the meds! Thanks to Sarah Mallak for making me aware of this one.

Also, this should not stop you from prescribing meds for your pets (there's even Reconcile-literally Prozac for your dog) Also, the FDA just approved Pristiq or desvenlafaxine for use as well-the advantage over Effexor-XR is there is no ramp up period when initiating therapy. Not to ruin there marketing campaign too much, but I'll quote Conway and say "Scam." Hopefully I don't get hit with a slander lawsuit for that one.

E-prescribing

2008-02-29T00:06:00.002-06:00

Thanks to Adele Reichel and Rachel Root, "Guest Bloggers" for submitting some info on e-prescribing:

E-prescribing is definitely something we will all hear more about. Here are some questions for thought:
• How will this impact your practice?
• What would you say to a physician in order to convince her/him of the important role e-prescribing can play in healthcare?
• Do you think this method would work for controlled substances?
• What will you do with the time you were formerly using to process prescription claims?
• The Fox News article states, “Doctors received an annual bonus for prescribing more generics.”Are pharmacists rewarded for dispensing generics, why/why not?

For further consideration, here's the letter from APhA to President Bush. Also, for further information on some examples of e-prescribing companies, check out RxHub and SureScript (p.s. checkout the RxHub ePrescribing 101 Overview as well.)

Scratch your trip to Azerbaijan...

2008-02-27T22:12:00.002-06:00

Bummer, I know. According to the WHO, the incidence of Multi-drug resistant TB is at the highest level, and is also at it's highest level ever. What is MDR-TB? Well, I would tell you, but I haven't started studying for my therapy test. As always, Wikipedia has the answer (from now on, I'm going to abbreviate that statement as AAWHTA) The WHO also has a great site on tuberculosis as well. MDR-TB is also highest, oddly enough, in eastern Europe and the countries of the former Soviet Union. Why? Poor funding for TB drugs, slow diagnoses of MDR-TB and stopping treatment before cure. However, Africa only provided info on 6 countries which may skew the results. Now, geography wasn't my strong point, but I'm pretty sure there's at least 8 countries in Africa, possibly as many as 10 (no really, look at a map. Also, they also have the highest incidence of TB, so take the info in the report with a grain of salt. If you really want to get into the report-go to the actual report. But, you better have some serious spare time.

Easing prostate cancer

2008-02-25T22:06:00.002-06:00

There's been a few prostate cancer pieces brewing, so I'll combine the two topics into an enlarged (prostate) posting. Okay, that was uncalled for, especially for such a serious disease, but I couldn't resist.

A venture capital company, Dendreon, that develops biotech drugs that target cancer, is currently conducting Phase III trials into a vaccine for the disease. As this article details, an advisory panel to the FDA recommended approval, but afterwards two panel members suggested a go slow approach. Here's where it gets interesting: These two panel members then came under fire for possible conflicts of interest. Congress was asked to investigate, they refused, and now there is a bit of a storm-Read the bottom of the Pharmalot blog for the comments from organizations that say that 20,000 people have died due to a few doctors that have financial interests in competitor companies.

A couple of weeks ago, Dendreon had a press release that they hope will change the FDA's mind and fasttrack the vaccine-again a report from Pharmalot (gotta love that blog.)

Another development in prostate cancer care looks to reverse the side effects to androgen-deprivation therapy that is used to treat prostate cancer (One good thing about writing this blog-it makes me really interested to learn more about what I write about-I guess it's a good thing that "Learner" is one of my strengths according to this book.) The drug, toremifene, has previously been marketed and used under the brand name Fareston. However, according to a Phase III trial from the company, GTx, there is a possibility that it can also be used to lower the incidence of fractures. More info is also on the WSJ blog.

More bad news for Vytorin

2008-02-23T11:14:00.002-06:00

I think this news shows you need to make sure your studies are a) well designed b) you don't make suspicious moves to secondary endpoints and bring in new investigators during the study and c) if you do all of those bad things-don't try and hide it. Though the study didn't show that Vytorin was superior or inferior-one always has to ask "What are they hiding?" and the effects of that decision are starting play out. The American College of Cardiology is meeting in March, and will release a statement on the trial then. But, will it be too late?

"Imagine there's no drug ads, it isn't hard to do"

2008-02-22T17:30:00.002-06:00

Could it be possible? According to a blog post from the magazine DTC Perspectives (yes, there actually is a magazine dedicated to DTC, but it looks like the only perspective they take is their own. They even have a national DTC convention. It's in April if you want to go, but I don't think MPSA will be reimbursing for it.) Here's some articles from WSJ and Pharmalot on it too. I would take some time and check out the DTC Perspectives website too and just look a bit more at the market that has emerged for drug marketers. Though I imagine most pharmacy students are against DTCA, I think it's interesting to look at what they consider when they market, trends they watch, and, of course, how much they spend (one study put it at more than what they spend on R&D, but it wasn't the best study.) One thought-get some DTC out there about MTM and pharmacists. We just need a mascot as cute as the Nasonex bee or Rozerem beaver.

Another napping article? Really?

2008-02-22T17:26:00.002-06:00

Apparently sleeping during the day is big for the Brits, because this is the second article on the topic in as many days. (See below for the other note.) Now, I'm all for napping, but I guess I need to make sure it's on my schedule. I also don't know if this study accounted for students in a pharmacology lecture or not...

Mirror, mirror, on the wall...

2008-02-21T20:16:00.002-06:00

...which flu bug will we see this fall... Sounds like choosing the bugs for next year's flu season is going to be pretty tough-they will be changing all three strains for the first time ever this year. It's kind of shocking that they have to develop it this far off. I suppose I'll forgive them for missing on it a bit this year.

And now for something completely different

2008-02-21T10:59:00.003-06:00

So, I saw a couple of things that weren't exactly drug related, but still pertinent, so I'll just throw them all into one post.

Cat-naps=good according to this article. Of course, I'll still take a longer nap whenever I wants to. Something to remember when you are cramming late at night for those dang therapy exams. Just remember to wake up after 6 minutes.

Your patients won't care how much you know until they know how much you care. Sometimes overused, but still an important idea. This article from CNN/Oprah.com was passed on to me by someone who doesn't think I am empathetic enough-I won't say who. Anways, a lot of what it talks about is very pertinent to think about when we talk with our patients and being more empathetic and better caregivers.

Google: The saviour of EMR? So this topic raises so many questions and concerns that I won't even get into, but Google is looking at storing health records online. Good? Bad? To be decided...

Drug prices rising

2008-02-21T10:57:00.000-06:00

It's not really news that drug costs are raising, but more that the rate that they are increasing is increasing. I think this is called something in calculus, but due to my pump and dump studying strategies, I don't remember what it's called. Anyways, here's the WSJ article on it.

Pharmacy's "Dirty little secret"

2008-02-19T08:05:00.002-06:00

Last night (Feb 18) Henri R. Manasse spoke about "Leadership with Integrity" and how pharmacy needs to continue to push the profession forward, admit its mistakes and understand how to improve them. One thing he mentioned, that others have also noted is the area of errors in pharmacy. For third years, this is especially noted as many of our lectures lately have dwelled on this topic, and Dr. Hadsall sent out similar articles (we'll get to them below.)

The way that Dr. Manasse brought up the issue was in the context of technicians who are not adequately trained, both in the community and in hospitals and health-systems, calling this the profession's "dirty little secret." Obviously, errors can not be blamed on a particular person-we are all to blame. But well trained technicians and certified technicians can greatly help minimize errors. Also, the Pharmacy Technician Certification Board conducted a survey and found that the general public overwhelmingly supports technician certification, and most thought that training and certification was done anyways.

Media coverage on errors, like what recently was posted on USA Today in an ongoing series called "Rx for errors." (Check out the graphic on how prescriptions are filled as well.) The series also has suggestions on how to safeguard against errors like consulting with your pharmacist as well (Brilliant!)

Dr. Manasse said that errors will still occur, but taking a defensive stance on the issue helps no one-realizing that the system isn't perfect and looking to improve it is what will help things. The USP also issued a statement on the most commonly confused drugs, and technology can help as well. Understanding that errors occur is one step to move the profession forward, and lead with integrity.

Flu shot a little bit off....

2008-02-14T18:59:00.002-06:00

So...this kind of sucks. According to the CDC, their prediction of which B virus was going to be popular this flu season was a bit off. Confused by that report, me too-Here's a better one from CIDRAP-the Center for Infectious Disease-Research and Policy that is at the University of Minnesota and an article on it from the Wall Street Journal blog.

Also, here's a little FAQ on how they select the viruses they put into the vaccine, and some other info as well in case you need a refresher...like me.

Another recall....

2008-02-13T13:57:00.002-06:00

Note to self-Don't have surgery this week. In addition to half of the heparin across the country being pulled, Duragesic patches made by Johnson and Johnson are also being recalled as well due to accidental overdose when the patches fail.

This article had a lot of interesting points (how much Johnson and Johnson grossed on the patches even though it's generic, new drug-Ionsys-that's having problems) but there was a statistic that really jumped out at me: They estimate that 2 patches per million have failed-around 64 total. But one patch failing could kill someone-so at what point did they decide to recall the patches? Perhaps a case for an Ethics case analysis....

More trouble for Baxter

2008-02-13T13:45:00.002-06:00

You may recall that Baxter was sued earlier by Dennis Quaid over confusing packaging-there is a post earlier on this. Well, looks like Baxter is in a bit more trouble now as well due to allergic reactions to their meds. Here's a link to FiercePharma with an article on it.

Retail Clinics the next step?

2008-02-07T23:34:00.000-06:00

A bit of a follow-up to the discussion on healthcare from the WSJ blog. Is it possible that Wal-Mart (and other similar models) could save healthcare? Important notes: Average cost-$50, and over half of the customers are uninsured. I think this indicates two things: A normal doctor's visit or ER is too expensive or takes too long and that people are willing to pay for health care...as long as it's affordable.

New clopidogrel study

2008-02-06T20:45:00.000-06:00

A new clopidogrel study was just released in JAMA that found that patient's risk of heart attack after ceasing use of clopidogrel doubled when they stopped using Plavix nine to twelve months after a stent was placed. (Bloomberg article here) The study was carried out in VA's around the country (120 or so) and wasn't funded by the drug company. It also raises the question of where the benefit of stents was coming from-from the stent itself, which has come under scrutiny as of late due to build-up of clots around the metal tubes.

For your edification and reminder, as well as a chance for me to showcase the hyperlinking capability of blogs, here are links to previous clopidogrel studies that show the possible benefit of this highly touted (and prescribed) drug, here are a couple of commentaries and dissection of the trial that set the standard of prescribing for clopidogrel prior to this study, the CURE trial. Here's one in the ol' favorite JAMA and one from respected heart hospital Cleveland Clinic's journal.

Debate on National Health Care

2008-02-06T14:08:00.000-06:00

Universal health care. Generally, that phrase is used as rhetoric to guide voters to support that particular candidate. Michael Moore used his documentary Sicko to play with the idea, and also pointed out the many flaws in our current system. Our own Quynh Nguyen commented on this movie and topic as well in Student Pharmacist.

This past month, the New England Journal of Medicine had a great commentary on our broken system, or non-system. It also brings up the safety-net, part of which our HRSA-PSCC grant helps to support. This commentary points out that any major shift in policy has to come from our leadership responding to public opinion as it did with the FDR's New Deal in 1932 and with LBJ's Great Society in 1964. Recently, the Clinton health care reform proposal was brought forth by then First Lady Hilary Clinton. (I like Wikipedia.)

There is no end of commentary, research, opinions and examples from other countries of the pros and cons of universal health care. It's a tough concept for us to imagine here since we our current system has essentially lasted for the past two generations. Whether it's right or wrong to pursue universal health care, I think we can all agree that something must change. What that change will look like, will, for better or worse, come from our elected officials. The more we make our voices heard, the better chance we have of having an influence.

And one more study from JAMA looking at the approval ratings of health care in seven countries. Moral: I'm moving to the Netherlands.

Medicated creams and lotions

2008-02-06T09:53:00.000-06:00

Laura Behm forwarded this CNN article on to me, and it's a good reminder that OTC meds can be dangerous as well. The story of Arielle Newman is especially notable for me-I remember hearing about it last year and warning the high school kids I was coaching to be aware that excess use of even OTC meds can be extremely dangerous.

I also received this article from Tom Welch. It reminds us of the importance of counseling patients and the effect meds can have. It has an 8-step reminder system for patients. With the untimely, and apparently drug-related, death of Heath Ledger, hopefully it will serve as yet another wake-up call for the importance of pharmacists. Here's the latest on Heath at WSJ.

New HIV drug

2008-01-31T11:24:00.000-06:00

More HIV news: The FDA, just last week, approved a new drug, etravirine or Intelence. Here's the press release. A quick high point though: This non-nucleoside reverse transcriptase inhibitor is effective when other NNRTI's have established resistance and is the first drug in this class that accomplishes this.

Shopping for Health Care

2008-01-31T10:52:00.000-06:00

This past weekend, I attended the MPhA Winter Clinical Conference-some meetings not great, some really good. One of the better ones highlighted a project that Drs. Schommer and Schondelmeyer (and others) have been working on for the past few months.

Drug companies, due to direct-to-consumer ads and other marketing (where they spent, just on direct-to-consumer ads, nearly $6 Billion in 2005!) have been great on getting their name out and information...on their new brand name drugs. To attempt to improve the information on non-marketed drugs, the U of M PRIME Institute began to develop information on drugs that were almost as effective as the brand name, but generic. More information on this project can be found at crbestbuydrugs.org. I encourage you to direct your patients to this website, and ask Drs. Schommer and Schondelmeyer for more information if you are interested.

In addition, a new website just started as well. You likely have heard the advertisements or seen the billboards on https://www.carol.com/ a new website that allows you to shop and compare health care. It will be interesting to see where this leads, and if this "shopping" for healthcare allows greater effectiveness in the use of health care flex spending accounts.

An option to an HIV vaccine

2008-01-30T22:03:00.000-06:00

Hey, third years, do you remember your HIV drugs? Yeah, me neither. But maraviroc/Selzentry prevents the virus from binding to the cell, and then enter into it. According this WSJ article (which, by the way, I realize I need to pay much more attention to since it seems they have the most up-to-date information regardless of the fact that they are owned by Rupert Murdoch now) Pfizer is taking a different approach to preventing AIDS. If you remember back to last fall, Merck halted their research into the HIV/AIDS vaccine realm due to findings that more people were contracting HIV after the vaccine than those in the control group....yeah. But this takes a different route, namely, the vaginal route. Pfizer is even working with a non-profit to develop this, and hopefully release it to women in areas of high occurence. A very interesting approach to prevention....

Perceptions of drugs and Big Pharma

2008-01-24T10:29:00.000-06:00

First off, I recently found out that "Big Pharma" is actually an organization, cleverly called PhRMA. Just an interesting factoid. Anyways, there was a recent study released by the New York Institute of Technology looked at the perceptions of people aged 18-26 and what they thought about medications, advertising and Big Pharma. Here's the link to the article on the study, as well as some actually pics. It's encouraging to see that most surveyed realized the importance of drugs, as well as the possibility of side effects. People also requested more information (see the top question on the second chart) And, who is better than drug information than us. Obviously, an opportunity to step in and offer information, and be a resource. I think we can also realize that advertising, thought totally biased, can stimulate conversation with patients.

Just for the taste of it!

2008-01-23T23:46:00.001-06:00

A University of Minnesota study, published in Circulation, found that fast foods-including diet soda-were correlated with a higher risk of developing metabolic disease, which is strongly correlated with later development of diabetes. Here's the MPR article. This supports a study out of the University of Boston from last July that had similar findings. It is important to note that both studies acknowledged that the diet soda may just be indicative of other behaviors that are contributing to the higher risk, fast food likely being at the top of this list. Here's another good summary from the trusty ol' Star Trib as well.

Adults don't like shots either...

2008-01-23T23:33:00.000-06:00

Or at least that is what this study says, well the CNN article says so. I couldn't find the actual CDC report-but I'll work on it. Anyways, opportunity for education by pharmacists, perhaps? I think, yes. Especially when you think about how cost-effective vaccines are in the long run.

Role of Depression in Diabetes and Osteoporosis

2007-12-07T23:45:00.000-06:00

I've usually thought about osteoporosis being a fairly independent thing-you have low calcium intake or other risk factors (age, gender, ethnicity, family history) and you have a higher chance of having lower bone mass. Seems straightforward.

Well, maybe not. A recent study funded by the National Institute of Mental Health and published in the Archives of Internal Medicine recently found that premenopausal women who are depressed have an elevated risk of developing osteoporosis-so much so that the initial findings indicate that clinicians should consider even mild depressive disorder to be a risk factor on par with smoking, low exercise, and low calcium intake. As usual, BBC.com has a good article on the topic.

In addition, a Canadian study looking at SSRI use in post-menopausal women doubled the risk of fracture. This article was also published in the Archives of Internal Medicine back in January. There is also a BBC article on it as well.

Osteoporosis isn't the only disease that is affected by depression-diabetes is as well. A study out of the University of Pennsylvania found that being more aggressive with depression treatment in patients with both depression and diabetes prolonged their lives. It's interesting to not that the patients in the study that died weren't dying of suicide-most were related to cardiovascular death. I was only able to find the abstract out of Diabetes Care on this one, and here's the blog article where I first saw the topic.

Chantix follow-up

2007-12-05T19:14:00.000-06:00

I mentioned this last week, but I saw a follow-up story and thought I'd drop it on the blog as well. A family in Britain is blaming Chantix (called Champix in Britain) for the suicide of Omer Jama. A Pfizer representative states that no studies have linked suicidal thoughts to the use of Chantix, and that nicotine withdrawal can exacerbate underlying psychiatric problems.

Who's at fault?

2007-12-05T18:49:00.000-06:00

Dennis Quaid is an actor, a pretty good one actually. He and his wife also have newborn twins. While in the hospital, the hospital staff used heparin to flush out the babies' catheters. Nothing unusual there. But what was unusual was the strength of heparin used: 10,000 units/ml instead of 10 units/ml. Yeah, that's not good. Luckily, it appears they were given protamine soon after to reverse the heparin effects, and things came out all right. Here's an article with more info.

However, the story doesn't end there. The Quaid's are suing, but they are not suing the hospital (which took full liability) they are suing the company that supplied the heparin-Baxter. Here's a good video from CNN. Now at first blush, this seems like the typical American use of the legal system: I'm going to SUE you!!! But here's what I think is pretty cool: They are only suing for $50,000. Obviously, they're not doing it for the money-they merely want Baxter to change the problematic packaging (three newborns died in Indianapolis last year with the same mixup) and admit their mistake. I think this is very admirable, and shows the power that publicity has to do good. Maybe I will have to check out The Alamo after all....

Interesting NY Times Essay

2007-11-30T11:28:00.000-06:00

Tom Welch passed this one on to me-I thought it was a pretty interesting essay. We focus a lot of attention on DTC advertising, but the marketing campaigns at PHRMA works through many different avenues. We are used to seeing drug reps at pharmacy meetings and events, but what happens if it's just a doctor giving a talk? This lengthy essay from the NY Times gives one doctor's experience giving drug talks. Here's a brief interview with Dr. Carlat in response to his article, as well as his blog that undermines a lot of what he did as a drug company representative.

Chantix concerns

2007-11-29T11:16:00.000-06:00

More FDA stuff...The FDA issued an early communication about the possibility of some possible concerns of erratic behavior and suicidal ideation that is possible with Chantix. Here's some more info on the Pharmalot newsfeed as well that goes into further detail.

Zetia not as good as their marketing plan?

2007-11-29T11:00:00.000-06:00

So, Zetia has some pretty nifty commercials and they are awfully scientific looking. But, apparently their actual approach to good science isn't quite up to snuff. Thanks to Dominic for sending the following links-

Here's a New York Times article on the issue questioning their delay in releasing information and changing primary endpoints. For a funny analysis of the topic, check out the Drugmonkey's blog here. **Caution-the Drugmonkey uses language not commonly used in a pharmacy (at least hopefully not used) so those with sensitive eyes, beware.

FDA Conference on Behind-the-counter status

2007-11-17T15:59:00.000-06:00

On November 14th, the FDA heard comments from the general public-they are listed here. It's 88 pages long, just to warn you, but if you search for the name "Michael Mone" he spoke on behalf of APhA. He also has some Minnesota ties as well, so that's pretty nifty. Here is a more accessible format of the APhA statement.

I have not yet seen any replies from the FDA or any kind of summary. They are traditionally pretty slow moving, so I wouldn't expect any kind of movement for a while. However, on a slightly related note, Zyrtec is now available over the counter, and Zyrtec-D is behind the counter. As more medications like this are released, with both OTC and BTC status, the third class of drugs is essentially being created. But, will pharmacists take the opportunity to become more involved with their patient's health care when they aren't required to?

MRSA Follow-up

2007-11-07T17:47:00.000-06:00

Ahhh, back to our favorite topic-MRSA. As a follow up to the previous post-Andy Behm from Express-Scripts sent a few drugs that are either approved or in the pipeline, as well as a clarification of what "approvable" means in the process.

The most recent drug is Doribax (doripenem) that was approved a few weeks ago for IV use. It falls in the carbapenem class (Remmel is going to get to this soon, so I know nothing on the class as of right now-sorry) but it can be used for complicated intra-abdominal infections and complicated UTI's-so it's effective agains both gram positive and gram negative infections. For further details on what doripenem treats-head here.

The following three drugs that he mentioned are in the "approvable" classification according to the FDA. Andy said that this means that the drug is on the right track towards becoming approvable, and there are a few more things that need to get worked out, like further testing or come up with appropriate labeling. For an interesting discussion on "approvable" letters and how companies respond (and how investors look at the drug development process) head here.

The first drug that falls in this class is the aforementiong televancin-check this one out below. Another drug that is "approvable" is Pfizer's Zeven (dalbavancin). Besides having a sweet brand name-great marketing, Pfizer-dalbavancin works by inhibiting peptidoglycan synthesis and blocking cell wall formation by binding the D-alanyl-D-alanine that is found on precursors of peptidoglycan. For a longer summary of the drug-head here. Also, Pfizer bought the rights to dalbavancin from Vicuron, who first submitted the New Drug Application in 2004.

The third and final drug passed on by Dr. Behm is a drug from Arpida called iclaprim. It works by inhibiting dihydrofolate reductase, and has effectiveness against many different bugs. However, it seems to have met with a critical crowd as evidenced by this article and this one.

As a final note, oh loyal blog-watchers, I wanted to throw this final thought out: When I was looking through these articles, I realized many of the articles didn't discuss the effect and benefit that having more medicines that are effective against resistant strains available and the improvement in treatment this would bring, but on the economic boom that resistant bacteria bring to big PhRMA and their stockholders. As the market share of the treatment of nosocomial infections grows from $10 billion last year to a predicted $40 billion by 2010, it seems that like sharks to blood, drug companies are laboring to bring their drug to market faster and claim a piece of that pie. To see how many companies are looking at this possibility and drooling-look here.

The Pharmacist's true Halloween Terror: Medication Errors

2007-10-31T20:17:00.001-05:00

I think we all remember the 20/20 piece from last spring-if not here's the video for a reminder. For further comments-here's the ABC blog with many comments on either side-so I won't belabor the topic here....too much ;-)

A positive aspect of this whole topic, however difficult it may be to discuss, is that is acts like a "Call to Action" in the public and in the media (again with the media discussion, Jared...seriously-we get it.) Towards this end, CNN now has an "Empowered Patient" series that encourages patients to be more involved in their health care. This week, the main article deals with minimizing pharmacy errors and ways to talk to your pharmacist and what you can do to minimize pharmacy errors.

I also found a newsletter that you can receive from the Institute of Safe Medication Practices that looks pretty interesting. The ISMP is an entire area that we don't hear anything about-and with the public concern of medication errors, I think we should make this more of an issue and be more proactive about it, rather than reactive.

The more we look at medication distribution and realize that the value that pharmacists add to the health care system is not in distribution but our cognitive services, the further I believe we can push the profession and practice the way we feel it should be practiced. Reducing medication errors are a HUGE area where we can make a difference, but we also need to let the public know that pharmacy is SOOO much more.

What happens if MRSA gets confused with MPSA?

2007-10-31T18:49:00.000-05:00

....oh, the implications. So....I do indeed make bad jokes. Whatever.

Usually, conversations with friends and family that turn to pharmacy will either be them a) showing me a rash b) complaining about how much their co-pay is and not realizing how much is actually being paid for (that's another blog...) or c) questions about what I want to do when I graduate, to which I usually espouse the multitude of opportunities available in pharmacy. Now, however, the new questions have revolved around MRSA-methicilling resistant staph aureus.

The original questions began after the CNN article ran a couple of weeks ago, in response to the JAMA article and also the death of a student who contracted the infection at school (and other deaths that are now coming to light.) Though MRSA has been an issue and of concern in hospitals for years, it is great to see this get people's attention and have more people realize the impact of antibiotic resistance and its implications. Still, it's pretty scary to think when the "Vancomycin resistant Staph Aureous" super bug comes along, or linezolid resistant, etc. There is at least one drug-Televancin that recently received an "approvable letter" from the FDA that is in the pipeline and not too far from approval-I'm not sure of others.

In addition, there is always the prevention route to slowing down the spread of MRSA. While some hospitals will likely do a deep clean to rid the hospital of the bug-this BBC article suggests that merely keeping up on general cleaning, even with just soap and water, cleans up the bug. Of course, proper and frequent hand washing is the biggest step in preventing the spread of this "superbug."

Also, last weekend over MRM, there was a very interesting proposed resolution that requested cleaning our white coats. I was at first like much of the rest of the contingent at the meeting, and thought the resolution was a bit hammy-but the explanation of the reasoning was not far at all from being off the mark. In Britain, there is a possibility that there may be a ban on white coats, and many hospitals, at the suggestion of the British Medical Association, have already banned ties across the pond. I think this was a great idea and a very proactive approach to helping resolve the MRSA problem, and a huge opportunity for student pharmacists in the US to take an opportunity to help public health and stop the spread of infectious disease (and don't get me started on the internet resolution....)

Pharmacist Indicted for Med Error

2007-10-18T11:11:00.000-05:00

Mistakes. We all make them. But, to what extent should we as pharmacists be held accountable? In Ohio, a pharmacist is being indicted for a med error that led to the death of a 2 year-old girl-here's the link. The discussion on the matter and impact on the profession is also very interesting and the ethics surrounding it are intriguing. There is also mention of mandated pharmacy technician training as well. Here's an article that goes a bit more in depth on the circumstances of the error and subsequent death, as well as more information on Emily's Law.

Eric Cropp, the pharmacist who performed the final double check on the chemo IV that ultimately killed Emily Jerry, has had his license revoked. Here's the testimony from the Jerry family. It's pretty intense, just to warn you. Here are the Ohio State Board of Pharmacy Minutes of that session-the testimony and conclusion are on pages 21-25.

A lot to think about witht his issue-we could probably hold an entire meeting discussing this as we did with the 20/20 piece on med errors last year. I'll try and keep everyone updated on this one.

Taxol not as effective as first thought

2007-10-10T20:03:00.001-05:00

This article from the Star Trib was forwarded on to me, and I thought it was very timely for what third years have been studying. Taxol or paclitaxel is used for women with breast cancer, but it appears to be more effective in women who are HER-2 positive. I will write more later-here's the New England Journal of Medicine article as well.

Topiramate for treatment of alcoholism?

2007-10-10T11:56:00.000-05:00

Topiramate/Topamax is commonly used for epilepsy and for migraines. A new study suggests it may be effective in treating alcoholism as well. Here's the CNN article on the topic, and the JAMA article on it too. Though it didn't work for a ton of the study participants (all of whom were heavy drinkers/alcoholics) it did work for a statistically significant proportion of people. Overall drinking decreased in both arms. There are quite a few limits to the study, but it didn't sound like the manufacturer of Topamax, Ortho-McNeill, was interested in pursuing FDA approval for the drug, though they did fund this study. Just to be cynical, Topamax goes off patent next year, and according to the CNN article, they can't market Topamax for alcoholism unless it's FDA approved for the condition.

I thought it was interesting that they felt it was moving towards what Prozac did for depression, and give, in this case, alcoholics a more private way to deal with their illness, rather than entering rehab clinic to dry out. A couple limitations to the study as well: They only followed the patients for 14 weeks, the dose seemed a bit high and thus caused a high incidence of side effects, and, like smoking cessation, I'd really be interested to see this double blinded to included some behavioural modification/support with it as well. Interesting direction with treatment of alcoholism, we'll see where it leads.

Student Pharmacists on Morning Shows

2007-10-10T11:31:00.000-05:00

I think we mentioned this in a meeting or two, but this definitely deserves more notice. On Oct. 4th, pharmacists and student pharmacists hung around outside of a bunch of morning news programs and got some airtime, and encourage everyone to, say it with me: "Know your medicine, know your pharmacist." Here's the APhA press release and some pictures of the event. I looked for videos of the event, but didn't find anything. If I do, be assured I'll post it. But, just for good measure, here's a little enjoyable video that many of you may have seen already.

FDA to consider new class of drugs

2007-10-09T10:29:00.000-05:00

The FDA has been making some pharmacy news lately, which only makes sense for the Food and DRUG Administration. Apparently the FDA announced back in March at the Annual Meeting in Atlanta that they were going to look closer at the creation of a third class. This floated under the radar for most of us, until the FDA released a statement announcing that they were going to have a public meeting on November 14th to discuss the issue (it's in Washington though...bummer. Oh, and it's a long statement from the FDA too, I think it's just kind of cool to have the original document posted. Gotta love the internet!!) Here are a couple articles on the issue as well: a CNN/Dowjones article and a Reuters article that is a little more in depth and some commentary from mainly OTC companies (they're against it) and from the National Association of Drug Chain Stores (they're for it).

This will be a very interesting story to follow in the coming months, and though I won't be able to make it, here's the link to register for the meeting in D.C. Let me know how it is. However, for a more accessible way to voice your opinion, here's the link to submit comments to the FDA-the link is open until November 28th. Here's your chance to tell the FDA what you think about having a third class of drugs!

Clean Air Act Credited with decreasing Heart Attacks

2007-10-04T12:00:00.000-05:00

A recent study in New York found that their 2003 Clean Air Act may have contributed to an 8% drop in heart attacks. Aside from returning from bars and NOT smelling like smoke, I guess an added benefit would be a decrease in risk of an MI. BONUS!!

FDA Updates

2007-10-04T11:57:00.000-05:00

A couple of people have let me know about this, so I had better blog on it.

The FDA is beginning a "Drug Safety Newsletter." This will be a quarterly newsletter that will keep you abreast of drug safety reviews, the Adverse Event Reporting System, and many current drug updates. Looks like the blog might be getting replaced after only a couple weeks....

Type II Diabetics QOL Study

2007-10-03T16:12:00.000-05:00

Thank you to Ryan Pederson, ex-pres, for forwarding this on. I'm a little late in posting it, and I apologize for that.

This is an absolutely fascinating article discussing the quality of life for diabetics patients. I couldn't find the actual article online (stupid journal limited access....ggrrrrr) but here's the abstract on it.

The gist of the article is this: Patients diagnosed with Type II diabetes would rather deal with the complications of the disease itself i.e. kidney issues, increased risk of cardiovascular death, blindness, loss of limbs etc. in exchange for not having to take all the pills to lower blood glucose, diet and exercise, insulin, and deal with the inconvenience and cost of dealing with their diabetes now.

I think the quote by the lead author Dr. Elbert Huang, assistant professor at the University of Chicago makes many good points:

"The people who care for patients with a chronic disease like diabetes think about that disease and about preventing long-term complications. The people who have a chronic disease think about their immediate lives, which include the day-to-day costs and inconvenience of a multi-drug regimen. The consequences are often poor compliance, which means long-term complications, which will then require more medications."

I think his statement raises many, many questions. How do we as pharmacists approach our treatment? We look at it as a correct answer-Patient has disease X, we treat with drug Y. Next question/patient. Real life, or so I am told since I'm just a student, is a bit more complicated. How will the patient respond, how do we respond, is this what the patient wants, etc. And all of this then deals with compliance, which is of course a huge concern because (and this may come as a surprise to many of you) if you don't take a drug, it doesn't actually work.

I was also very surprised by this for a moment, but then after some thinking about it, I realized that a patient that has had poor diet and minimal exercise-a lifestyle stereotypical of many Type II diabetics-probably won't really like trying to jump through all of the hoops necessary to turn around their lifestyle of poor health.

Other ideas that I won't address since this is already meandering and verbose-but what about the burden on health care for their end-of-life care, how do we then treat patients that aren't complying, and are we simply enabling their poor health by not chastizing them on their lack of compliance

CFC to HFA Albuterol Inhalers

2007-10-01T09:15:00.000-05:00

If you work in a community pharmacy lately-you've probably noticed the change from the CFC albuterol inhaler to the HFA inhalers-most likely to the "ProAir" or "Ventolin" HFA, or some others. Usually you just switch the patient over to the HFA inhaler, and none's the wiser-but are they really equivalent?

As Sarah Mallak discussed in MPSA, though there are a lot of similarities between the two options, there are some special consideration we as pharmacists/students need to think about when we dispense them to patients, particularly for the first time. Patients should be instructed to wash their HFA inhaler canister once a week in warm water to prevent clogging. Further information can be found on the article "Withdrawal of albuterol inhalers containing chlorofluorocarbons" in NEJM-I'd link it but I'm not able due to restrictions. A very interesting read!!!

Preliminary study on effects of caffeine and acetaminophen

2007-09-26T21:32:00.001-05:00

First off, I would have put Tylenol, but someone doesn't like me using brand names. And I'm all about making everyone happy. I saw a few articles on this, and I thought it was interesting. I think the comment that sums it up is "there are a million miles between E.Coli and humans." However, there is some very serious validity to this article. Here's the link to the Fox News article (no comments on the source, please) It also had an interesting few words from Dr. Steven Lidofsky that even mentioned Cyp2E1 possibly being responsible. Kind of crazy to see that in a general article like this one.

Here's a BBC article on the topic too. Apparently paracetamol is the same as acetaminophen. Oh, those crazy Brits!

Also, this only pertains to high doses of caffeine, so it didn't seem to cause concern with migraine meds that contain caffeine and APAP or Fioricet, oh, excuse me-the butalbital, caffeine and acetaminophen combination drug commonly referred to as Fioricet.

I tried to find the original article on this one; if I do find it, I'll be sure to post it, my faithful blog-reader(s).

HIV Vaccine Progress Halted

2007-09-24T11:48:00.000-05:00

James Bischoff pointed this BBC article out to me: Merck, as I'm sure many companies are doing, has been working on a vaccine for HIV, primarily testing on people who are at high risk for contracting HIV: gay men and sex workers in Africa. An independent panel recently suggested halting the trial, saying it was headed for failure. The article says that Merck had been working on the vaccine for 10 years. Hopefully some other vaccines are in the pipeline to treat this disease.

FDA and New powers to watch advertising

2007-09-21T23:20:00.000-05:00

Ok, so they can do more than just watch advertising, they can actually stop advertising they deem misleading. I originally heard this on NPR Moneymarket-here's the link with the script of the piece below. If you read the whole thing-you'll see this, but I want to make sure you hear about it: Last year drug companies spent $5.3 billion on advertising. Not research. Not manufacturing. Advertising. But, when you think about all the ads you see for drugs, it makes sense. I also don't know if that was OTC and prescription, or just prescription drugs just to let ya know.

Another good article on this is in the LA Times, found here. It goes into much more detail of how the new Senate bill expands the role of the FDA and gives them more proactive powers. It also discusses the creation of a database that scans for pharmacy and insurance records for patterns of medication problems. Obviously-this is a much more active and more powerful role for the FDA, something that many people say is long over due.

In regards to the database-Two things I consider when I think about this issue. First, I think this could be a big step forward towards creating a more unified drug monitoring system. Think about it: If the FDA can link pharmacy and insurance records, how far off is it before they are looking for patients that are on duplicate therapy or are abusing narcotics? I have no background whatsoever in the topic, but it's something to hope for. On the contrast of that though, is of course cost. Increased monitoring obviously necessitates increased funding. This comes from tax-payers of course, but also from drug companies who must also pay millions of dollars to the FDA for them to review their New Drug Applications. Pros and cons to both.

Flu Update

2007-09-20T21:51:00.000-05:00

With flu season approaching, third years studying hard to prepare for their immunization clinic and American Pharmacists Month getting ready to advertise to the world that people need to be immunized, several questions come to mind-Will their be enough vaccines? Whatever happened to bird flu? Who needs to be vaccinated?

Well, how about the first one: Will their be enough vaccines? I just saw an article on Time (always a reputable medical source...but hey, we're not getting too in depth I suppose) that states the CDC will have around 132 million vaccines-but, not everyone who should get vaccinated, does get vaccinated. This article does go into pretty decent detail about who should be getting the vaccine, but ask any third year student for more details. I know I'm learned up!! Also, this articl also mentions that the FluMist vaccine is now approved for children down to the age of 2-so classmates, you can be confident in putting that answer down for next weeks quiz!

Another item that has been around for the past couple years, and that is of course, the Avian Flu or H5N1 (so, it's a Wikipedia link, but it has a good summary of the flu, sorry for my references). Also, here's a link to the CDC current situation-Nothing too current, but of course it's not to flu season yet. I hate the "Wait and see" method, but with no vaccine, I guess that's what we have to do. And hope to be at the front of the line for Tamiflu.

"Poisonous Cocktail"

2007-09-19T21:32:00.000-05:00

Recently in the New York Times, there was an article discussing the danger of multiple medications and really not keeping up on what you are taking, understanding the risks. For many of us, this is of course, obvious. It's what we are trained to do-understand people's medications and side effects, etc. But how many patients know this, or think of their medications as inert, and not the potential poisons they are?

I'm not posting this article or discussing it in the meeting this Thursday simply because of the content-I think it also illustrates two important items that we will focusing on this year: The importance of media and the role that it can play in influencing behavior and health literacy.

When I was reading this article, even though it is an op-ed piece, I couldn't help but think: How many people will read this? And how many of them will take a look at their meds, and think "You know, I'm on a couple of these medications..." Or that they are getting older, or don't understand why they are taking their meds, or chronically use OTC medications... Think of how many more patients this article reaches than what we as students do to encourage patients to know about their medications? Media has such a powerful voice, and that's why for American Pharmacists Month we are making such a strong push to engage the media-but more on that later.

Another note-read the language in this article. I don't know a whole lot about "health literacy" but it struck me how simplistic this article was written, but yet how easy it is to read for most patients to read. But, more on that later as we near MRM and the "Embrace Health Literacy" workshop.

HC Squared

2007-09-19T00:51:00.000-05:00

Health care * Hilary Clinton=News. I'm not sure if it's because I listen to NPR while stuck in traffic (which happens a lot if you drive 94 at 8am and 5pm) but I've heard quite a bit of press devoted to this in the past day or two, and we are almost 14 month from the Presidential election. The last time there was this much hype and money thrown about was the race for MPSA president....oh wait....

Back to the topic at hand: Health care, and more importanly health care reform. Me, personally, I'm not all that politically informed beyond listening to the radio, which works well because I don't want to be biased on this blog. I save that for my other blog: http://www.jaredisalwaysrightnoquestions.com/. But, I thought I would dig a little deeper for you MPSAers and provide some info.

Hilary Clinton's last foray into health care reform occurred way back in 1993-94 when her hubby was president. In fact, Dr. Schondelmeyer served on the committe that worked on this project. I was about to enter the awkward age of puberty so I don't remember too much about it, but it was a big defeat for what became known as "Hillarycare" She was pretty much lambasted for her role, and it very likely will taint her next effort to take on the health care crisis. Lots of comments can be found, but here is the CNN article on her plan here. If I see an interesting comment or discussion, I'll try and post it, or if you, the loyal blog-reading public see one, please post it on the comments section.

I don't think I need to lay out how important all of this is to pharmacy. I think we all have experienced the patient that doesn't have insurance, or has recently gone off insurance and is buying medications that may keep them or a loved one alive. I don't know the right answer to solve the health care crisis, but it doesn't take an intelligent person to point out that at some point, something is going to have to change. Whether that is this plan, or something very different, I think we and the rest of the public need to look through the individual plans themselves before criticizing and saying it won't work. My two cents.

Diabetics like Inhaling Insulin

2007-09-14T22:47:00.001-05:00

So, this is kind of interesting-according to a recent study, use of Exubera over insulin acheived comparable results, but patients had greater satisfaction. An interesting point with this-the patients were aged 12-17 and had type 1 diabetes. Check it out here.

Health Disparities Lectures

2007-09-13T21:35:00.000-05:00

There are a few of us that are taking the Cultural Competency class, taught by Dr. Doneka Scott and Dr. Paul Ranelli. It is a class that will deal with the wide health disparities that still exist between different groups of people in the U.S. Though these lectures aren't a part of the class, I wanted to make public, or at least as public as this blog is (i.e. I check it from multiple computers, and no one else does) a couple of public lectures that Dr. Scott let us know about.

"The Role of Health Services Research in Closing the Health ServicesGap for Racial and Ethnic Minorities"

The next Distinguished Visiting Scholar Series in Health Disparitieslecture will feature Margarita Alegria, Ph.D., director, Center forMulticultural Mental Health Research; professor, Department ofPsychiatry, Harvard Medical School and the Cambridge Health Alliance.The event will be held on noon-1 p.m., Sept. 21, in Moos Tower1-450G.

“The Elephants in the Room: Social Justice, Public Health, and Health Inequities”

Nancy Krieger, Harvard School of Public Health, will present 9:30-10:30 a.m., Sept. 28, at Coffman Union Theater. This event is part of the Carl J. Martinson, M.D., Lectureship in Preventive Medicine, presented by the School of Public Health’s Division of Epidemiology and Community Health.

When Dr. Fecik spoke of getting out there and experiencing things outside of the classroom, I feel he would say that these sessions would complement the list of 10 items that distinguish professionals.

Dr. Fecik's Speech-Professionalism

2007-09-13T20:25:00.001-05:00

Dr. Robert Fecik was our speaker for the Welcoming Banquet-and he gave a great speech about becoming professionals. He said it wasn't something that one achieves by simply sitting in a classroom and studying out of assigned texts-there is much more involved with it. A student must pursue interests with passion, to "Be Brave" and continually ask questions. He also spoke of Ten Qualities that distinguish a professional-something that I feel is a very difficult thing to define. These qualities were published in a White Paper and expanded upon in the APhA-ASP Toolkit. Of those ten, only a few were qualities that one could gain directly from the classroom; to achieve the rest, students need to find them in different settings: Professional organizations like MPSA or the fraternities and other organizations. Meaning, get out there and do something. And if it's with MPSA, even better.

Update on Witt's Pharmacy in Rushford

2007-09-13T10:36:00.000-05:00

Lots of developments for flood-damaged Rushford and SE Minnesota-cleanup continues and state aid is on its way. While this is great for the area, and support will still be given to Witt's Pharmacy, MPhA and Tom Witt say more help is needed-check out the letter here. Also, we at MPSA will have a bucket to pass around to collect support for Witt's Pharmacy-and MPSA will match donations up to $500!!! That's $2 for the price of $1!! I look forward to seeing you this afternoon at the meeting and at the Recognition Banquet!

Calling all Twin Cities Marathon/10 mile participants!

2007-09-11T17:51:00.000-05:00

For this year's American Pharmacists Month we will be recognizing participants who will be running in the Twin Cities Marathon, as well as have pharmacy students there to talk to the public and, of course, cheer participants on!! So, we want to know who you are!!! Send an email to Jared at ande7977@umn.edu if you are participating, or know a pharmacist who is participating, and we'll let you know how you can help out!

NAPLEX Suspension

2007-09-09T22:11:00.000-05:00

It's likely you have heard about this already, but a pharmacy prof at the University of Georgia was recently busted for giving students answers to the NAPLEX. More information here. Some of the comments below talk about the impact of the delay-Students losing signing bonuses, questioning the ethics of the profession and more. There are also many students who defend the professor and question why he is being persecuted-possibly because he is not affiliated with KAPLAN, ASHP, etc. Good discussions on both sides.

Relief for Witt's Pharmacy and Rushford

2007-09-06T23:53:00.000-05:00

In today's meeting, Craig talked about the need to help out in Rushford, in particular with Witt's Pharmacy-an independent pharmacy in the small town of Rushford Minnesota. The pharmacy's inventory, records and everything else were destroyed; but people still need their medications. MPhA has organized a relief fund and issued a release asking for help. Student's interested in heading down to Rushford can contact Craig at glie0008@umn.edu and be put in contact with people who are heading down to help out. We will also be passing around a bucket to collect donations to help get Tom back on his feet. Also, here's some current news on relief efforts from the Red Cross.

APhA Responds to CMS requirement of Tamper-Resistant pads for Medicaid patients

2007-09-05T23:46:00.000-05:00

For many in the profession, I think this one slipped in the backdoor. CMS, the Center for Medicare and Medicaid Services will require patients to have a prescription written from tamper resistant pads by October 1st. Here's a link to the article from APhA.

A couple things to think about:

As they say in the response-What about emergency prescriptions? And paying for the second dispense? Also, think about this: Pharmacies could possibly be punished for something that a physician is ultimately responsible for: the writing of the prescription. But, pharmacies and pharmacists will be held liable.

This bill was passed under an Iraq Defense bill, and little discussion occurred on it. But look at the implication that it has for the practice of pharmacy! If nothing else, I think this illustrates the power that legislative and political issues have over how we practice, and why it is so important that we stay active and involved on that front. We'll try and keep you posted on further developments.

Welcome

2007-09-05T23:39:00.000-05:00

Welcome to the new MPSA blog for the Twin Cities campus. We will try to use this as a forum to provide information on events in the College and MPSA, as well as happenings in the profession of Pharmacy. Let Jared know of anything that you think belongs on here, and we'll see what this becomes. Have a great year, and we'll see you at the meetings in WDH 7-135 on Thursday 12:15-1:15pm. Check out www5.pharmacy.umn.edu/mpsa/ for more information. Let Jared know what you think about the blog at ande7977@umn.edu.