Whatever Happened to Customer Service?

I’ve gotten a whole lot of new traffic on an old blog post of mine entitled, “Why That Prescription Takes So D**M Long to Fill and Why It’s Not Your Pharmacist’s Fault After All”.  There have been comments on both sides, of course, from  pharmacists and pharmacy customers.  Both have their frustrations and some seem more than frustrated – irate is the word.  People on either side of the counter can be rude and incompetent sometimes but when I ask myself where good old fashioned customer service went, I say, “It’s the system, Stupid.”

I was born in the 50’s, the halcyon days of good customer service.  Milk was delivered to our door.  The garbage men (we didn’t use the term “sanitation worker” then) came to the side of the house where the trash cans were kept and took them to the truck to be dumped.  Gas was pumped for you.  Humans answered questions on the phone.  Your neighbor worked at or managed or even owned your favorite store and always gave you free stuff.  You were pampered in airplanes.  In my lifetime customer service has gone from the very personal to the totally impersonal.  If you’ve ever tried to get an airline or a computer manufacturer on the line, you know what I mean.  What few customer service reps remain are outsourced to countries where problem-solving is limited to a script and communicating in English is a challenge.  Self-service is pushed on us on the phone, at the store and at the airport.  I get a lot of emails and store receipts asking me for feedback but if I complain, no one follows up.  Nothing seems to change.  If corporations are people, there’s not a one I’d like to go have a beer with.  Corporations, it seems, simply do not give a damn.

The lack of caring on the part of corporations is not limited to customers.  It’s aimed at employees, as well.  According to the Economic Policy Institute, worker productivity grew 80% from 1973 to 2011 while wages, after inflation, grew by only one-eighth that amount.  The minimum wage is still an unbelievable $7.25/hour.  (I was making that much in 1978.)  This year Forbes Magazine reported that CEO’s make 331 times as much as average workers and 774 times as much as minimum wage workers.  Benefit packages, health care, pensions and vacation time are shrinking.  If the compensation picture weren’t bad enough, the American worker has been vilified by politicians and the press.  Chris Christie, Governor of New Jersey, portrayed public workers as fat cat ripoff artists who receive “rich benefits” paid for by the citizens and referred to the teachers’ union, the National Education Association (NEA), as the “National Extortion Association”.  Nice.

The purpose of a corporation is to act in the interest of its shareholders, in other words, to make money.  Ethical and social concerns, therefore, are not only irrelevant – they are obstacles to this fundamental mandate.  The Citizens United decision has allowed corporate rights to further trump employee rights by granting them “personhood” and allowing a flood of corporate money to buy influence in Washington.  What does all of this have to do with customer service, you ask?  A system that exploits its workers cannot produce quality service.  Not consistently, anyway.  Dedicated professionals like healthcare workers, teachers, firefighters and cops give their best despite the squeeze being put on them but the burnout rate is high.  The new graduate nurse turnover rate in the US is about 30% in the first year of practice and as much as 57% in the second year, according to the journal American Nurse Today.  Low job satisfaction is related to inadequate staffing, insufficient time with patients, low wages, and dissatisfying relationships with peers, managers and interprofessional colleagues.  In short, a pressure cooker work environment breeds discontent.  Discontent does not lend itself to good customer service. And the story is the same, whether we’re talking about McDonald’s or the corner drugstore.

Turning this around will take a monumental effort.  I hope we will all educate ourselves about workers’ issues and get active. Speak out. Vote. Until then we can help one another by re-establishing another forgotten American virtue: mutual respect.  People on both sides of the counter, the desk or the bed deserve it.  We’re all in the same leaky boat that this country has become and we’ll paddle or sink together.









Back to Blogging

I have not posted anything new on this blog since 2011. I wrote the blog for my employer and stopped working for him that year. But the flurry of activity lately has given me the idea to write again. Even though I don’t work in the pharmacy arena anymore, the issues of healthcare are still important to me. I am married to an NICU nurse who’s in graduate school to become a family nurse practitioner and I help with typing and editing and researching. My personal POV is that healthcare is a mess in America but many of the people who work in it are smart, dedicated and put up with a lot – A LOT – to give the important gift of service that they give every day.
So there’s a lot to think about and a lot to say. Thanks so much for your interest and watch this space!


Here’s to Another New Year and Another 2nd Chance….!

Well, another year is almost gone. So long, 2011! From the earthquake and near meltdown in Fukushima to the antics of Charlie Sheen, we saw the kind of tragedies and scandals we see every year. And from Representative Gabrielle Giffords, who survived a gunshot in her head to Mohamed Bouazizi, the Tunisian street vendor whose protests sparked the Arab Spring, we were reminded of the courage and resilience that sustains us through it all. So I propose a toast to Edward Payson Powell who said, “The old year has gone. Let the dead past bury its own dead. The New Year has taken possession of the clock of time. All hail the duties and possibilities of the coming twelve months!”

The New Year is the time we look backward for a moment onto every unkindness we may have committed, every mistake, every thoughtless action. From there we look ahead. We can’t help ourselves – it’s a new page! A clean, white, unmarked surface ready for recording the new story we’re determined to get right this time. Harry Morgan, best known for playing Colonel Sherman Potter on “M*A*S*H”, died earlier this month at the age of 96. One of his best lines as Col. Potter has become a mantra for some: “The world is too big of a place to be in competition with everyone. The only person I need to be better than is the person I am right now.” From your mouth to God’s ears, Harry. If only each one of us would take responsibility for becoming the best version of ourselves, the world would finally receive a much needed makeover.

For some the year 2012 will be end of things, not a new beginning. There have been dozens of TV doomsday documentaries this year designed to scare the pants off us with stories of Hopi prophesies and the end of the Mayan calendar. Tales of Nostradamus and various versions of an inevitable 2012 Armageddon are coming fast and furiously now. But what if things ARE coming to an end, only not in a cataclysmic fire and brimstone sort of way? What if it’s just our old ways of doing things that’s finally starting to shift? What if all the unrest of the Arab Spring and the Occupy movement in the U.S. are the beginning of a new way of seeing ourselves and our world? What if we’re finally beginning to see that we’re all in this together? What then?

From all of us here at Apex Medical Placements to all of you – a very peaceful, prosperous, perfect New Year!








A Few Holiday Rants and Wishes

It’s Christmas/Hanukkah/Kwanzaa time again! And if your house is like mine you’re busy decorating, baking, shopping, cooking, wrapping, mailing and then going to parties where there’s always somebody complaining that they don’t “do” the holidays because they’ve become too commercialized. “You don’t do Christmas?” I would say if I only had a spine. “Then unhand that spinach puff! Step away from the eggnog! Why darken this holiday party, evil Grinch? Get thee to a funeral, and quickly, too!” Seriously. To the woman at Saturday’s party droning on about how she has no time for Christmas what with all her sad memories and the state the world is in (hot buttered rum in one hand and a cocktail shrimp in the other) – I have a message for you: make some new memories. Put one of those reindeer antler things on your head. Buy a sweater with a pom-pom for Rudolph’s nose. Break out the crystal and blow the dust off that bottle of wine. Take something over to the lady next door who’s all alone. Write a check to the food bank. Buy a toy for a kid who doesn’t have one. Because the perfect way to forget your troubles is to do something for somebody else.

We’ve all heard the excuses: Christmas is just for kids. The holiday has lost its meaning – it’s so commercial! What good is Christmas spirit if it only lasts one day? There’s so much sadness out there that I can’t celebrate and on and on…. Well, it’s true. Christmas IS for kids (and adults and puppy dogs, too.) It’s also been commercialized and yes, there’s a lot of sadness and suffering in the world. So how is boycotting the holiday going to make all that better, again?

Listen, for 364 days you’ve gotten up, gotten the kids to school, fed the cat, washed the dishes, put a load of laundry in, taken the car to the shop, gone to work, come home, cleaned house, fixed dinner, paid bills, repaired the broken toilet/computer/doorknob/lawn mower – it’s Christmas! Go on! Bring an evergreen into the house where you can smell it all the way into the kitchen. Hang all that stuff you made in 4th grade art class all over it. Make those cookies you love, you know – the ones with all the butter. Put the teddy bears on the mantle and hang a wreath on the door. It’s about doing things you don’t usually do. It’s about doing a little something wonderful for someone. It’s about making the day special. You’ve earned it.

Yep, the economy sucks and people are out of work. Folks have lost their houses. So be the change you want to see in the world, like Ghandi said. Call your Congressman. Send a few bucks where you think it will do the most good. Help someone. Then put a ham or a turkey or a roast in the oven and pour yourself a toddy. Buy some of those blinking Christmas ornament earrings or a Santa’s Sleigh necktie for your partner. Put a jingle bell collar on the dog. Play the Nat King Cole Christmas CD and turn it up – way up. Invite your friends. Send cards even IF no one’s doing that anymore. Throw a snowball. Bake some gingerbread and eat a piece while it’s still warm. Hang way too many lights on the front of the house. Act the fool. Count your blessings. Then envision a joyful, prosperous New Year for everyone, everywhere – no exceptions. Grin ear to ear.

From all of us here at Apex Medical Placements to all of you, a very Happy Holiday!

A Funny Thing Happened on Plan B One Step’s Way to the Drugstore Shelves…

Headline Washington, Thursday 8 December 2011- President Obama, who took office pledging to put science ahead of politics, averted a skirmish with conservatives in the nation’s culture wars on Thursday by endorsing his health secretary’s decision to block over-the-counter sales of an after-sex contraceptive pill to girls under age 17. www.truth-out.org

No doubt you’ve heard of the Obama Administration’s move to override the FDA’s decision to allow the “morning after pill” to be sold over the counter. It surprised the heck out of Teva Women’s Health, Inc., makers of Plan B One Step, when they heard their preparations to take the drug OTC were for nothing. One word came to mind when I heard about the decision: politics. Supporters of the decision say it’s a good idea because a pharmacist can still sell it to anyone who can prove they are at least 17 years old. Like many others who are uncomfortable with the idea of lifting the age restrictions on the sale of this product, Obama balked at the idea of a 10 or 11 year old being able to buy it “alongside bubblegum or batteries”. But there’s an election year coming up; my guess is that the president is ducking a 100% guaranteed confrontation by making sure One Step remains right where it is – behind the counter.

The FDA’s recommendation that the emergency contraceptive be available over the counter without age restriction was based on their research that said the pill was safe and effective for nonprescription use and that adolescents could use it properly without the intervention of a healthcare provider. Then the secretary of Health and Human Services (HHS), Kathleen Sebelius, stepped in. According to the British newspaper, The Guardian, Sebelius “was concerned that the manufacturer had not studied whether 11-year-olds, some of whom are capable of bearing children, would fully comprehend the product’s label and appropriate use.” Obama was very careful with his response; he voiced support for the Sebelius move while distancing himself from it. “As the father of two young daughters, I think it’s important for us to make sure that we apply some common sense to various rules when it comes to over-the-counter medicine,” he said. He also made it a point to say that he was not involved in the decision; he had left it up to Sebelius.

When it came to issues like stem cells, climate change, sex education and contraceptives, Bush’s administration watered down or outright suppressed the findings of government scientific agencies. So naturally the scientific community rejoiced when Obama vowed to “restore science to its rightful place” in his 2008 inaugural address. He has also said that he would ensure “that scientific data is never distorted or concealed to serve a political agenda.” But the evidence that Plan B is safe, effective and easy to use suggests that the Sebelius decision was not determined by science at all. Plan B works by suppressing ovulation and is 89% effective in preventing pregnancy if taken within 72 hours of unprotected sex. It has no serious side effects and will not terminate a pregnancy that has already begun. Plan B, therefore, is a contraceptive, not an instant abortion pill, as some anti-choice groups would have us believe. Quite the contrary. Research by the University of Chicago shows that since 2006, when emergency contraception was made widely available, it “lowered the risk of unintended pregnancy…and played a significant role in the decline of abortion between 2005 and 2007.” Moreover, a 2009 study in the journal Obstetrics and Gynecology showed that women and girls as young as 12 have consistently demonstrated a good understanding of how the drug is used and when they should use it. Sounds like good scientific evidence to me, but despite the findings of these and other studies, Sebelius nixed greater accessibility to the drug and cited “scientific uncertainty” to justify her action.

I suppose we could argue all day about how certain “scientific certainty” is, anyway. But the fact is that the FDA routinely approves drugs before every bit of research that could be done on them has been done. Many medications on the market have not been assessed for safety and efficacy for use in children, for example, or for women or people over 65. The difference is that with Plan B we’re talking about sexually active 11 year-old girls who are capable of becoming pregnant. There’s an “ick” factor here – discomfort with the idea of adolescents having sex lives and becoming parents. The Washington Post reported that Obama aides admitted that the decision wasn’t about science, but about a “gut feeling that teenagers might not be ready to make decisions about pregnancy.” Guess what, Mr. President, the minute adolescents choose to have sex they are making a decision about pregnancy – no matter how ill-informed or unconscious that decision may be. And speaking of ideas that are of questionable scientific merit – many Americans still believe that providing access to sex education and contraception will give kids the idea sex at any age is OK, so we have curtailed access. My grandson, for instance, just completed a sex ed module in his 7th grade health class. A permission slip was sent home for me to sign, outlining the content of the lessons. The subject of birth control was not mentioned. Parents had objected, apparently – too many kids having sex too early. The American Public Health Association reports that 33% of teens have had sex by 9th grade. That’s age 14, folks. Something tells me that refusing to educate kids about birth control isn’t working.When Obama and Sebelius refused to put themselves on the record by saying that making Plan B available OTC to adolescents made sense, they were simply refusing to grab hold of the teenage sex/contraception/abortion hot potato. Taking a stand means risking controversy, criticism and votes. So as politicians are wont to do, they took the easy way out and rejected the science on Plan B based on claims of “scientific uncertainty”. Slick.

The FDA decision promised to poke a great, big hole in America’s provincial attitude about sex but for now, anyway, Plan B One Step will remain off drugstore shelves. That’s unfortunate because wider access to the drug would be a safe, effective way to reduce the teenage pregnancy rate. And that rate, despite our collective head-burying, is on the rise. As long as the Obama administration continues to make women’s health decisions based on politics, we will continue to maintain the status quo. Looks like religion, emotion and kneejerk reactions trump science once again.

Yaz – The Sad and Sorry Saga of America’s Best-Selling Oral Contraceptive

If you were a woman between the years of 15-25 and in the market for an oral contraceptive, you might very well ask your doctor for a product called “Yaz”, and you’d have plenty of company. The maker of Yaz, Bayer Health Care Pharmaceuticals, enjoys $1.8 billion in sales from the drug annually. No wonder. Females between 15 and 25 years of age have been targeted by Bayer’s formidable advertising campaign and promised much more than just a contraceptive. Yaz is Bayer’s “magic pill”. But the real question should be, “Magic for whom?”

The boys at Bayer may have perked your interest when you were watching “Grey’s Anatomy” or some other prime-time TV show and saw an ad for their contraceptive wonder drug. They claimed Yaz to be “Beyond Birth Control”. Yaz isn’t just about preventing pregnancy – it’s about your LIFESTYLE. You know those nasty pre-menstrual symptoms? Bloating. Fatigue. Muscle aches. Headaches. Increased appetite. Anxiety. Irritability. Moodiness? Step right up, ladies, and get your bottle of Yaz. Guaranteed to treat every pre-menstrual symptom you’ve got. And as a bonus your skin will clear up, too! After a sales pitch like that, who wouldn’t run to their OB/GYN and ask for a prescription? The trouble is that Yaz is no better at preventing symptoms of pre-menstrual syndrome (PMS) or curing acne than a sugar pill. And Bayer knows it.

In 2009 the Food and Drug Administration (FDA) and the attorneys general of 27 states required Bayer to run new ads to correct their claims. “Regulators,” according to the New York Times, “say the ads overstated the drug’s ability to improve women’s moods and clear up acne, while playing down its potential health risks.” You can say that again. Side effects associated with Yaz include depression, migraines, breast lumps, high blood pressure and cholesterol, vaginal bleeding, hair loss, weight gain, cervical cancer, potentially life-threatening allergic reactions, liver damage, pulmonary embolism, deep vein thrombosis and blood clots that cause strokes, vision problems and heart attacks. Experts say lawsuits for health-damaging side effects may well reach 25,000 or more before all is said and done. And that number doesn’t include the numbers of women afraid or reluctant to file a claim against Bayer.

Take the story of Carissa Ubersox. In 2007 she graduated with a degree in nursing and went to work in pediatrics. On Christmas Day of that year her boyfriend surprised her with a ring while she worked the day shift. Dreaming about the big day and wanting to look her best, Carissa switched to Yaz after watching a commercial that promised it would help with bloating and acne. “Yaz is the only birth control proven to treat the physical and emotional premenstrual symptoms that are severe enough to impact your life,” claimed the ad. Carissa was taken in. Three months later, in February of 2008, Carissa’s legs began to ache. She didn’t pay much attention at first, attributing the pain to working 12 hour shifts on her feet. Then one evening she found herself gasping for air. Blood clots in her legs had traveled to her lungs and caused a massive double pulmonary embolism. Her fiancé called 911 but on the way to the hospital her heart stopped. She was revived but slipped into a coma for two weeks. When she woke up she was blind.

“It sounds like a miracle drug,” Carissa remembers thinking after seeing the Yaz commercial. You might ask yourself how a medical professional like this got fooled. Nurses take courses in pharmacology and most are not like Joe Average who just wants his problem solved and asks his doc for the latest, greatest pill. Carissa undoubtedly knew that blood clot risks are associated with all oral contraceptives. The trouble is that Bayer went out and marketed this drug even though they knew the chances it would cause an embolism were higher than those other pills – 6.3 times higher, or in different terms, 630% higher. In 2009 a Dutch study published in the British Medical Journal (BMJ) said that the type of progestin used in Yaz, drospirenone, was associated with more blood clots than other forms of the hormone. Other research has shown that low-estrogen oral contraceptives made with a type of progestin called levonorgestrel carry the lowest risk of blood clots. There were already dozens of alternatives to Yaz on the market. Bayer didn’t need to create a new contraceptive at all so they made a pill and attributed great abilities to it – all to get a patent and profits. Lots and lots of profits. Three other studies besides the one in the BMJ showed similar kinds of increased risk with Yaz. That didn’t stop the FDA from saying Bayer could sell it anyway. Hundreds have now died or been incapacitated by strokes, embolisms and heart attacks after taking the drug. Yet the pharmaceutical industry in this country is such a force that the FDA is still holding meetings to decide whether or not to do anything about it. Yaz is still on the market and is America’s number one best selling contraceptive.

The real tragedy is that Bayer knew all this. There is new information coming out every day about how bad this product is. Bayer’s conduct is so rotten that in 2008 it was fined $97.5 million by the government for running a kick-back scheme with Liberty Medical Supply, promising to pay bonuses for every patient converted to Bayer diabetic supplies. The company then had to enter into a Corporate Integrity Agreement with the Department of Health and Human Services. This agreement says Bayer can’t be trusted; it has pled to felonies and incurred incredible fines – up to $250 million. That’s what we do in America when a corporation causes harm because we can’t go the company and arrest someone. Corporations may legally be people, my friends, but they can’t be thrown in jail. As a result, when a company like Bayer wants to market a new drug they know is dangerous, they just run the numbers. They say, “Look, all we have to do is get the drug to market. Once we get FDA approval it’s going to be five or six years, no matter what kind of complaints come in. We’re going to get five or six years of sales out of this product.” At a rate of $1.8 billion in sales every year, even a $250 million dollar fine is chicken feed.

In the face of this story and dozens like it, whether from the pharmaceutical, coal, automobile or food industries, big business is constantly lobbying Congress for fewer regulations – and succeeding. We have a good ‘ol boy system, where if you go to work for the FDA, chances are you’ll go to work for Bayer. Or Pfizer. Or Abbott, Roche or GlaxoSmithKline. The people who have allowed this to happen are still allowing it to happen, even after all the body counts are in. The FDA simply says, “Well, we’re going to put a committee together who will decide how long this is going to go on.” That’s because companies like Bayer can make phone calls. Mike Papantonio, author and prominent tort litigator, refers to the phone calls as “Billy Bob calls”.  “That’s where they call Billy Bob who works for the FDA,” says Papantonio, “and says you know – I don’t think these facts are right. I don’t think these statistics are right. I think this study is bad. Could you let us keep this product on the market? And by the way, Billy Bob, we may have a position for you when you leave the FDA.” Uh-huh. And Billy Bob’s $68,000 salary working for the government becomes a cool quarter million in the private sector.

No matter how egregious corporate behavior has become in America, there is still a lot of effort on the part of politicians to slash regulations and limit awards paid out in lawsuits. The law firm that defends Bayer will make millions but lawmakers would have their client say to the person who is killed or maimed that $150,000 or $200,000 in damages in enough. Not only are the politicians pushing it – many voters are buying it.

Well hey, you can’t blame them. Life is just great when there’s no one looking over your shoulder. That is, if you’re a sociopath.

Questions Your Pharmacist Never Wants to Hear Again But Will Anyway

Knowing what to ask your pharmacist isn’t hard: what’s this medicine? How do I take it? Will it make me bleed from my eyeballs? These questions are just common sense. But the questions you should NEVER ask the pharmacist – now that’s a different issue. They don’t, for example, like questions about the location of the toilet paper. I found that out the hard way. I always figured hey, the pharmacist works here – he must know where the TP is! But from the look on his face I gathered that the title “Doctor of Pharmacy” and the lowly bog roll were not compatible. Lots of questions that should be common sense NOT to ask are asked all the time, so to ensure that your next trip to the neighborhood pharmacy is a pleasant one, avoid the following. Your pharmacist will thank you (and also won’t report you)!

 ·         Are you sure about that? This question is posed by the customer who stares at the OTC bottle of medication she is unsure about, narrows her eyes suspiciously at the pharmacist and stares at the bottle again. This is AFTER a conscientious pharmacy tech has picked the product out especially for her, placed it in her hot little hand and then deferred to the pharmacist’s long and careful explanation of why it is the product of choice for her situation. “But the label says….” Yes, the label does say that, but as the pharmacist has already explained, there is an exception in your case. Whereupon the unbeliever turns on her heel and tosses the bottle next to the rawhide treats in the doggie aisle. Look – why did you bother to ask if you already knew? Don’t assume, unless you have a Pharm.D yourself, that you know more than the white-coat-wearing apothecary that stands before you. You don’t.

·         I don’t really need to take these, do I? This is the kind of question that will make your pharmacist’s mouth drop open the first time she hears it. No – of course you don’t need to take these. You’ve been to a doctor who told you your heart is working like a swimming pool pump full of mud, come across town to drop off your prescription, then come back a few hours later to claim your little bottle of life-preserving medication. But you absolutely, positively do not have to take it. You might, however, want to check if your will is up to date.

·         Can’t you just fill it? Now hear this: a pharmacist who is on the ball won’t fill a controlled medication even one day early. Ever. Physicians may call and “tell” the pharmacist to fill early but it will be refused. The reason? Pharmacy boards fine pharmacists for filling early. Your pharmacist’s license is on the line so he will check his state-controlled database of patient profiles if he doesn’t know or trust you. For him, this is a way of protecting his license. For the pharmacy board, it’s a way of protecting the public. If a pharmacist feels uncomfortable, he doesn’t have to fill. And he doesn’t have to explain to anyone, not even his CEO, why he feels uncomfortable. Your pharmacist is the licensed healthcare professional that keeps the pharmacy open – don’t screw with him.

·         That long? Yes, Virginia, it will be that long. You’ve already waited in line more than 15 minutes this week at the bank, at the restaurant and at the movie theatre. But obviously giving that pill jockey behind the counter time to get your life-saving prescriptions right isn’t worth your time. There’s a lot more going on back there than pill-counting. You see, your insurance company won’t pay for the brand name drug you need without prior authorization. That means your pharmacist must pull on his boots and slog through telephone hell to listen to automated responses, wait on hold and be transferred several times just to be disconnected. When he does reach an actual human he attempts to track down your doctor only to find she is busy with an emergency. The doc on call has apparently been called by someone else just now so you’re going to have to come back later. Retail pharmacists are realists – they rarely tell anyone it will only be 15 minutes wait time. They’ll tell you 30 minutes minimum and one hour if it’s busy. Which it always is. Calling for a refill? Two hours, non-negotiable. No whining or pleading. If you don’t like the wait time you can go somewhere else….and wait there.

·         How much Sudafed can I buy at once? Oh, brother. You’re what’s known as a “Sudafed Man” in pharmacist circles. You go from pharmacy to pharmacy looking for 12-hour pseudoephedrine, a very dangerous chemical, which you will take and mix with other dangerous chemicals to make methamphetamine, which you will sell to people to inject into their bloodstream to get high. You buy pseudoephedrine often and get away with it by 1.) always paying in cash (no paper trail) and 2.) presenting a fake driver’s license. That is, until your pharmacist notices that the laminate on your license is loose. Oops. Dirtbag alert. No Sudafed for you!

·         Are you the pharmacist? The white coat and name tag that reads, “Joseph C. Blow, Pharm.D” notwithstanding, your pharmacist politely answers, “Yes, I am. Can I help you?” But you look so young, say you! “Thanks for the compliment! Now what can I do for you?” I need a pharmacist with more experience, say you (this problem with your GoLytely is highly technical), can I speak to someone else? Well, I’m the only pharmacist on duty, fella. You can come back in a few years if you like.

·         Can I ring these up here? Oh, sure! Your pharmacist just loves it when you bring a truckload of foot powder and baby wipes back to ring up with your prescriptions! Listen, there’s a bunch of other registers out there in the store. You want it fast? Then let the pharmacy clear the line as fast as possible and take your cart to a cashier.

Oh, and another thing – when they say “45 minutes” it’s because at that very moment there is a 45 minute wait. No – not because you’re fat, or old, or remind them of their ex. It will take approximately 45 minutes to fill your prescription accurately. You see, it might really be closer to 30 minutes but then the phones go crazy, people jump in line with groceries and make-up, and John Q. Public wants to know where the jock itch is. After that the insurance company doesn’t want to cover and yes, your pharmacist knows this is not your problem. But be assured no one is in the back filing her nails or texting his girlfriend. The waiting room may look empty but there’s about 50 people waiting for their prescriptions to be filled in the next 20 minutes. This may look like a convenience store but it’s also a pharmacy – not the 7-11. If you really want it fast, next time call ahead. Otherwise, grab a magazine and sit down. Take a load off – there, now. Better?


Thanksgiving – America’s Day

(To mark the holiday we’d like to pass along a couple of personal messages. Have a great holiday, everyone! –CVH)

Thanksgiving is a verb, a word of action. Giving thanks demands that we acknowledge the people and events around us who have made our successes possible.  A quick look around gives us many reasons to give thanks and our thoughts turn gratefully to those who have made this progress possible.  A smile to a stranger, a ‘paying forward’ of a good deed, an acknowledgement of a good deed well received or a forgiving nod recognizing the humanity in all of us are all wonderful ways of giving thanks.

Let me borrow and paraphrase the famous lines from William Shakespeare’s The Merchant of Venice when Portia speaks to Shylock in Act IV, Scene I.

The quality of thanksgiving is not strained. It droppeth as the gentle rain from heaven Upon the place beneath. It is twice blest: It blesseth him that gives and him that takes.

You have to admit; that guy had a way with words!

Any internet search will bring you all sorts of insights into the ‘meaning of Thanksgiving’ or the history of harvest festivals around the world with each cultures particular ‘spin’ on the observance. For me personally, I have always marveled at the fact, that we as a country, community, society, family, etc. actually set aside a day to enjoy each other and count our manifold blessings.

As I reflect on this Thanksgiving Day, I think back to the many blessings we have encountered this past year. While they are too numerous to list here and now, they must not be ignored.

Each year brings new challenges. This year has certainly been no exception. We have met those challenges and look forward to meeting future ones with strength and honesty towards our mission. We entered this business with the purpose of bringing a better model to the pharmacy staffing world and are continuing to adjust our business model to best serve each specific market requirement. Thank you each and every one for your individual contributions to helping us meet those challenges.

For those of you who have blessed us with your pharmacy business or are contemplating our services, we thank you. For those of you who have represented our company or are awaiting new assignments, we thank you each. Your trust in allowing us to help fill your needs is deeply appreciated. We are honored.  I count each and every one of you as part of our blessings to which I am eternally thankful.

In this spirit we say simply and sincerely, thank you and best wishes for a Happy Thanksgiving.

Best regards,

Thomas Denton, CERS, CPC, CTS

Apex Medical Placements, Inc.

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Happy Thanksgiving! We’re all going to take a break this week to celebrate a holiday unique to America, a day that has become associated with the settlers at Plymouth who celebrated and gave thanks for their safe arrival to the New World. But the holiday did not become official until 1863 when President Lincoln proclaimed that a national day of thanksgiving should be celebrated annually. For me, the date of Lincoln’s proclamation, October 3, 1863, has always spoken to the holiday’s true significance. We were deep in the middle of the bloodiest, most divisive conflict of our history. The Civil War would not be over for another two years and yet Lincoln did not wait until its conclusion to designate a national day of gratitude. Instead he chose to reach down into the death, suffering and despair and seize upon everything that we, as a nation, still had reason to give thanks for. In July of that year 75,000 men of the Confederacy confronted 97,000 Union soldiers in Pennsylvania and fought the battle of Gettysburg. The total number of killed, wounded and missing after the three days of fighting totaled a staggering 50,000. Yet in his proclamation Lincoln said, “The year that is drawing towards its close has been filled with the blessings of fruitful fields and healthful skies. To these bounties, which are so constantly enjoyed that we are prone to forget the source from which they come, others have been added, which are of so extraordinary a nature that they cannot fail to penetrate and soften even the heart which is habitually insensible to the ever watchful providence of Almighty God.”

Likewise may we, amidst all the struggles and disappointments of the present day, never fail to recognize America’s many blessings. There is much to be grateful for. From all of us here at Apex Medical Placements, have a warm, wonderful Thanksgiving!

Cynthia von Hendricks, Administrative Assistant

Apex Medical Placements, Inc.



To Get the Right Answers, Ask the Right Questions

October was American Pharmacist Month and hopefully it raised awareness about pharmacy and pharmacists. If you’re like most of us you’re probably annoyed when your doctor hustles you in and out of his exam room in 15 minutes flat. But I’d bet even 10 minutes is too long to wait when you’re picking up a prescription. Once the doc has written that prescription we tend to put our brains in neutral. But what do you really know about that pill you’re about to pop? Unless you have a very unusual physician it’s likely that he or she doesn’t (1.) discuss your prescriptions with you and (2.) doesn’t know a whole heck of a lot about the benefits and downsides of the drugs he prescribes. There is, however, a remedy for this rather scary and pathetic situation: your friendly neighborhood pharmacist is a drug expert and the master where everything pharmaceutical is concerned. You just need to know which questions to ask:

Why am I taking this medicine? Now there’s a concept – actually understanding why a particular drug has been prescribed for you. Yet you’d be amazed at how many people never think to ask. My mother, for instance, a depression era baby, would never dream of questioning her doctor. In her generation it just isn’t done. What’s your excuse? All drugs, including prescription ones, are potentially dangerous – even lethal. Ask your doctor WHY you need the medicine being prescribed and how it’s going to help you. Discuss your concerns and get all the information so you can decide if you want to take it. (Yes, it really is your decision.) If you don’t want to take it, ask your doctor for a treatment that is more acceptable. If your doctor resists, ask a pharmacist. Oh, and then find a different doctor.

Brand name or generic? If you weren’t confused enough already, that drug you’ve been prescribed has more than one name. The first one, its brand name, refers to a new drug that has been developed by a pharmaceutical company. After a new drug is formulated, its maker files for a patent to protect against other companies copying and selling it. At this point the drug has two names: the generic, or the drug’s common scientific name and the brand name that makes it stand out in the marketplace. Think acetaminophen vs Tylenol.

Generics in the U.S. must match the brand name med in almost every way, both in the strength of the active drug it contains and in the way it acts in your body. This is called “bioequivalence”. The real differences lie in the way the products look (color and shape) and how much they cost. (Occasionally the difference in inert ingredients can present a problem for some individuals – ask your pharmacist if the generic is right for your situation.)

Brand names cost more because manufacturers want to cover the costs of researching, developing and advertising the drug – don’t think it’s because the brand name is superior.

How do I take this medication? According to Dr. Dorothy L. Smith, author and patient education expert, the cost to purchase all prescription medications in the U.S. in 2000 was about $111 billion dollars. But the cost to treat complications from home medication errors was $177 billion! Add to that another $100 billion to cover employer costs resulting from absenteeism and loss of productivity from home medication errors. Deaths from medication mistakes at home increased from 1,132 in 1983 to 12,426 in 2004 – an increase of more than 700%. Americans not only don’t know what they’re taking, they don’t know how to take it. Consider these tips:

§  The average person forgets 50% of their doctor tells them – ask your pharmacist to go over the instructions.

§  If you don’t feel comfortable talking to the pharmacist over the counter, ask for a private area. More and more pharmacies have them.

§  Lots of people stop taking their medicine because they think they’re allergic to it. Actually, they may have had a minor side effect. But allergic reactions can be very serious. Ask if you have a question!

§  Know how to take your medicine correctly. This might seem like a no-brainer, but “Take one tablet 3 times a day” doesn’t give you enough information. Your pharmacist can help you work your dosage schedule around your meal times and activities. Also, some medicines, such as asthma inhalers, are complicated to take. Your pharmacist can make sure the medicine reaches your lungs, not your throat.

§  Understand what to do if you accidentally skip a dose. Understand the sometimes serious side effects that can occur if you stop taking your medicine suddenly.

§  Are you taking OTC drugs or herbal remedies? They can interact with your prescription. Make sure you discuss them with your pharmacist.

§   Side effects – every drug has them. You need to know how recognize them because some are serious. Others are just annoying but you need to know how to manage them.

§  If you’re having trouble remembering to take your medicine, don’t be afraid to tell your pharmacist. They can help you find a way to jog your memory.

§  How long should take your medication? Some drugs are for a specific duration, like antibiotics or pain meds. Others, like heart medications or diabetes drugs, are for life. Stopping antibiotics prematurely can have dire consequences, so take your meds for the time prescribed and let your pharmacist know if problems develop. Never, never, never, stop taking antibiotics prematurely because you feel better and think you don’t need them!

How do I store this medication? Again, this is one of those things that seems obvious, but drugs can become toxic or inactive when stored improperly. Some drugs need to be refrigerated, for instance. Some are light sensitive or can degrade when exposed to the air. Most drugs should be stored in a cool, dark, dry place – they don’t do well in temperature extremes or in high humidity (like bathroom cabinets). Combining different meds into one bottle or vial is not a good idea, nor is keeping them in a plastic bag where they may break open or get crushed. Transdermal patches should be discarded carefully so kids and dogs don’t get into them. And you know those pesky childproof caps? If you don’t have kids around, you may not want them. I had no idea that the white plastic locking kind can simply be turned upside down and screwed on until my pharmacist pal showed me.

How do I choose a Pharmacy? Most people choose a pharmacy based on location or convenience (like the Walgreen’s around here that also sell booze – no, really!). But there are a ton of other services you may not know you want until you need them:

 §  What are the pharmacy hours? Are they open when you might need them most – like on holidays or in the middle of the night?

§  Does the pharmacy deliver? What are the restrictions? Charges?

§  How are emergencies handled during and after business hours? Is there a dedicated emergency phone number?

§  How long does it take to have a prescription filled?

§  Does the pharmacy stock the drugs you take?

§  Does the pharmacy staff look stressed? Are there long lines at the counter? (If you suspect staffing problems behind the scenes, don’t risk an error or sacrifice service – find another pharmacy.)

§  Is there a drive-through? Pharmacists hate them. I love them. (Never equate your pharmacist with the burger flipper at McDonald’s. She’s a professional and protecting your health and safety takes time.)

§  Are there exceptions to the kind of insurance they accept?

§  Do they accept credit cards? Do they have credit accounts available?

§  What health services are offered? Vaccinations? Blood pressure or cholesterol screening? Medication management for chronic conditions like diabetes?

How do I choose a pharmacist? Choose a pharmacist, you ask? I just go over to CVS and take my chances! Pharmacists don’t just put pills in a bottle. The role of today’s pharmacist is expanding and involves establishing a relationship with the patient to develop care plans for drug therapy. Ask friends and family for a pharmacist referral. Then get to know him and make sure he knows your medical history. Some other things to think about:

§  How does the pharmacist handle the phone? Is she harried? Disinterested? Or polite and informative?

§  Does the pharmacist have any specialties in disease management? This can be a real advantage if you have a chronic illness such as heart disease.

§  Is he easy to talk to? Does he take the time to explain new medications and answer your questions in a way you understand?

§  Select a pharmacist with the same care as choosing a doctor. A good one will go the extra mile for you when it really counts.

Your pharmacist is the real drug expert and is probably a lot more accessible than your doctor. So take an active role in your own health care – get to know your pharmacist and get to know your meds. It could save your life or the life of someone you love some day.

Next week – the questions you’re better off NOT asking the pharmacist!



Up in Smoke III – Medical Marijuana’s Got a Real Bad Rep

Consider the common cold. When you feel really rotten and reach for something to help you feel better, what is it that makes you choose a particular medicine? Say you ache all over, your head is stuffed up, and you have a fever, a cough and a sore throat. You’re presented with some options – a traditional Chinese extract made from astragalus root, a Mexican tea made from garlic, lime peel and honey, or Robitussin Multi-Symptom Cold Formula – which would you choose? Why? What is it that motivates you to pick one remedy over another? Our beliefs and experiences undoubtedly play a role in shaping our view of a medicine as legitimate. But the important question is how those ideas of legitimacy benefit us…or not.

A couple of weeks ago I wrote about the crackdown by federal authorities in California on medical marijuana dispensaries. An article in the N.Y. Times last Sunday described exactly what the feds are up to: “The Treasury Department has forced banks to close accounts of medical marijuana businesses operating legally under state law. The Internal Revenue Service has required dispensary owners to pay punitive taxes required of no other businesses. The Bureau of Alcohol, Tobacco, Firearms and Explosives recently ruled that state-sanctioned medical marijuana patients cannot purchase firearms.

United States attorneys have also sent letters to local officials…stressing their authority to prosecute all marijuana offenses. Prosecutors have threatened to seize the property of landlords and put them behind bars for renting to marijuana dispensaries. The United States attorney in San Diego, Laura E. Duffy, has promised to start targeting media outlets that run dispensaries’ ads.”

When Obama ran for president in 2008, he defended the use of cannabis as medicine and said he wouldn’t use the Justice Department to override state laws concerning it. But then he re-nominated a Bush appointee, Michele Leonhart, as the head of the Drug Enforcement Administration, so it’s no surprise that Obama’s policy on cannabis is the same as Bush’s, despite his campaign rhetoric. Leonhart has retained the classification of cannabis as a Schedule I drug with “no currently accepted medical use in treatment in the United States.”

When you think of cannabis, or more specifically, one of its street names: marijuana, pot, grass, weed – what comes to mind? Hippies? Mexican drug cartels? The kooky California counter-culture? Though the history of cannabis as a medicine goes back thousands of years, it was maligned as the vice of dark-skinned foreigners, destined to corrupt all that is fair and white and good in 1920’s America. In the 60’s it became associated with anti-establishment rebellion, violence and mayhem. Maybe you’re old enough to remember Cheech and Chong’s pot humor in the 70’s. I still have the Big Bambu album somewhere, complete with the giant rolling paper that came with it. Really, cannabis can’t be taken seriously as a medicine! Can it?

In March of 2009 President Obama attended a televised online town hall. Of the thousands of questions that were received in advance, the topic of whether the legalization of cannabis would improve the economy ranked fairly high. Obama didn’t take the subject seriously and said laughingly, “I don’t know what that says about the online audience. But no, I don’t think that is a good strategy to grow our economy.” No wonder cannabis has an image problem. Yet in 2004 at an event at Northwestern University then Illinois politician Obama told the crowd, “I think that the war on drugs has been a failure, and I think we need to rethink and decriminalize our marijuana laws.” Nothing has changed much since the Marihuana Tax Act of 1937 – cannabis is still the center of a game of political football.

I don’t know where Michele Leonhart gets her information, but there have been hundreds of studies conducted on the medicinal uses of cannabis. It has been documented as effective for the treatment of nausea, vomiting, premenstrual syndrome, unintentional weight loss, insomnia, and lack of appetite. It’s used to treat spasticity, neurogenic pain, movement disorders, asthma and glaucoma. It has been found to relieve certain symptoms of multiple sclerosis and spinal cord injuries. It may also  prove useful in treating (are you ready?) inflammatory bowel disease, migraines, fibromyalgia, alcohol abuse, collagen-induced arthritis, atherosclerosis, bipolar disorder, colorectal cancer, depression, dystonia, epilepsy, digestive diseases, gliomas, hepatitis C, Huntington’s disease, leukemia, skin tumors, methicillin-resistant Staphylococcus aureus, Parkinson’s Disease, pruritus, post-traumatic stress disorder, psoriasis, sickle-cell disease and sleep apnea. And yes, controversies remain. Should it be smoked or synthesized into pill form? What are the side effects and benefits of both? How should growing of the plant be regulated? How can the final product be standardized? Should it be? No doubt such questions arose in the long journey between the poppy fields and the manufacturing of morphine and Vicodin. But today opioids are accepted as serious medicine, approved by the FDA, prescribed by MD’s and dispensed by pharmacists in neat, labeled, tamper-proof plastic bottles. Where cannabis is concerned, we got stuck on the road someplace between William Randolph Hearst and the last doobie you smoked underneath the high school bleachers. And not only can cannabis assist in the treatment of pain and disease, it can do it without the toxic effects of many of the medicines we consider “legitimate”. According to a 1988 statement by the U.S. Department of Justice, “There is no record in the extensive medical literature describing a proven, documented cannabis-induced fatality. In practical terms, marijuana cannot induce a lethal response as a result of drug-related toxicity.”

If the ability of cannabis to ease pain and suffering hasn’t convinced us of the need to decriminalize its use, its potential as an economic powerhouse should. The illegal import of drugs into the United States is a multi-billion dollar a year industry with all of the profit going to criminal organizations. If cannabis were legalized and regulated the huge expenditure on the drug war and black market sales could be turned to far more practical applications. It’s interesting to note that economist Milton Friedman is a staunch supporter of the legalization of cannabis. He joined with 500 other economists in signing “An Open Letter to the President, Congress, Governors, and State Legislatures” which states that the legalization of cannabis “would save $7.7 billion per year in state and federal expenditures on prohibition enforcement and produce tax revenues of at least $2.4 billion annually if [it] were taxed like most consumer goods. If, however, marijuana were taxed similarly to alcohol or tobacco, it might generate as much as $6.2 billion annually.”

$14 billion ain’t hay. That doesn’t even include the proceeds of the legalization of agricultural hemp and its spinoff industries. Profits there, according to Dr. Dale Gieringer, author and state coordinator of the California NORML (National Organization for the Reform of Marijuana Laws), are anywhere from an additional $6-10 billion annually. And don’t forget jobs. In an era of 9% unemployment our consumer-driven economy would have a huge boost from the thousands of jobs that would be created in the agricultural, medical and manufacturing fields. I don’t know about you, but I hear a lot of talk these days that America is broke and that we just can’t afford to fund public education, infrastructure repair, health care, public transportation or social services and that we must cut back on the number of public sector workers like cops, nurses, firemen and teachers. Considering the decisions we make, the continued criminalization of cannabis among them, its little wonder our national finances are in a mess. I was more clear-headed than this back in the days when I smoked…and inhaled.