Reflections On a New Year

Every January 1st we have the opportunity of a do-over: a new year. 2011 offers us a fresh start on a new decade and yet, there really are no fresh starts; every year and every decade is on some level a product of the years and decades that have gone before. After all, we are the sum total of our choices. Since what we do in the coming year will affect the years to come, in what direction would we like to turn?

The traditional New Year’s Eve song, “Auld Lang Syne” is sung at the stroke of midnight to invoke “times gone by” or “long, long ago”. We invoke them so that we might forget them, and let go of a past that keeps us bound up in outmoded ideas, beliefs, and habits. From this hour on we have a clean slate and we want to believe that, during this next year, things will be better. People choose healthcare as a career because they have taken the hope of better days to heart. Pharmacy is one of the helping professions and behind the filling of each prescription and the advice to every patient or physician is a desire to improve the life of someone else. Every healthcare worker touches thousands of lives over the course of a career. They are the human face on a healthcare system that has become increasingly impersonal, even adversarial, in the US today. Each opportunity to reach out, to connect, is an opportunity to heal.

In the end, January 1, 2011 is just another day, with no meaning or power except that which we ascribe to it. New Year’s Day is simply a marker which divides an old year from a new one. But by celebrating that demarcation we also separate past mistakes from the promise of future triumphs. Maya Angelou once said, “When you knew better, you did better,” recognizing the power in our intention to make better choices and in so doing, make a better world.

Our hope is that the days ahead will bring you more joy, more laughter, more gratitude, more lightness, more friends and more love, and that the difference in you will make a difference in those around you. From Apex Medical Placements, have a dynamic, energetic, smashing New Year!

Finding the Spirit of Giving in the Healthcare Industry

Because the celebrations of Christmas, Chanukah and Kwanzaa all include the tradition of gift-giving, we have come to think of the holidays as a time of giving. As a kid I remember being told in Sunday school that Christmas presents were really birthday presents for Jesus that we give to one another to recall the gifts the Magi gave to the Christ child. During this holiday season I wonder what place the spirit of giving has in our modern healthcare system. At first glance it would seem that the Grinch-like claws of the insurance companies would choke the life out of any healthcare practitioner’s impulse to give to others through his profession. The season, it seems, belongs to Scrooge as insurance companies bully patients to use online pharmacies, attempt to substitute lower-cost prescriptions for the originals without consulting physicians and pressure pharmacies to accept tiny profits on the drugs they dispense. And we consumers, like Bob Cratchit, are left to carry the burden of the healthcare system on our shoulders with its skyrocketing costs and cutbacks in service. It seems the spirit of Christmas present may pass us by this year.

But despite the insurance industry’s strangle-hold on the profession, medicine is a helping profession. People still become doctors, nurses and pharmacists to serve. I came across a story recently about William Kennedy, a retired pharmacist who worked in Illinois for 42 years. He worked in a corporate pharmacy where the philosophy was to pay litigation settlements because it was cheaper than staffing more pharmacists to avoid errors. Although the budget guideline allotted 3 minutes per prescription, he made sure to counsel each and every customer. “The corporation didn’t like that,” he said, “because I wasn’t getting dollars into the cash register fast enough. There was no time allotted for counseling.” Then there’s the story of Becki Kuns, a fresh-faced graduate of Duquesne University, who sees herself as the liaison between physician and patient and emphasizes the importance of communication and relationship-building in pharmacy. Her goal is to begin a consultation program for diabetics because, as she puts it, “the disease is everywhere.”

Even though corporations like Walgreen’s and CVS seek to dominate the market, independent-minded pharmacists and independent pharmacies still provide alternatives within a high-volume, impersonal atmosphere. Hundreds of local pharmacies have closed in the country, places that once compounded prescriptions, offered vaccinations, delivery service, counseling and  pharmacists who you could call in the off-hours if you really needed help. The University of Washington’s publication, “University Week”, recounts a story of a business plan by student pharmacists to take over an independent pharmacy in Squim, Washington. It seems the current owner and pharmacist is retiring and wants to turn over the business to someone interested in continuing his mission of providing personalized customer service. The students put together a plan to grow profits without sacrificing the business’ service ethic and the plan will be marketed to potential buyers.

The next time you open a bill for medical services denied by your insurance company, it may help to remember that for every story about the ineffectiveness and greed of the healthcare industry, there are individuals finding ways around the system. It restores my holiday mood to know that healthcare workers, including pharmacists, still seek to serve their fellow man and not just at Christmas time, but all throughout the year. And that, I believe, would make my Sunday school teacher proud.

Happy Holidays from all of us here at Apex Medical Placements.

Recalls – A New Kind of “Tylenol Scare”

On September 29, 1982, a “Tylenol scare” began when the first of seven individuals died in Chicago after ingesting Extra Strength Tylenol that had been deliberately contaminated with cyanide. The incident shocked the American public because of its former belief in the safety of the nation’s drug supply. But Johnson & Johnson, manufacturer of the drug, quickly moved to protect its image as a trusted family-owned company; within six days it issued a nationwide recall of 31 million bottles of Tylenol from retailers.

Eighteen years later, in 2010, the OTC drug manufacturing picture has changed somewhat – and not for the better. By October of this year Johnson & Johnson announced its ninth recall of some of its products, including the popular pain reliever, Tylenol. One could argue that this year’s Tylenol scare is even more frightening than the 1982 incident because there is no madman to blame, but only the drug maker itself. The recalls are related to shoddy manufacturing practices and this time the company took 20 months to respond to customer complaints about a musty smell coming from the medicine. The odor is caused by a chemical called 2,4,6-tribromoanisole (TBA), a fungicide used to treat wooden pallets which then leached into the Tylenol stored on them. The nausea, stomach pain, vomiting and diarrhea reported after taking the tainted medicine seems rather benign at first until one reads the FDA statement that, “The health effects of this compound have not been well studied… ”

A Google search of the 2010 Tylenol recalls show top-of-the-page headings declaring that, “The Safety of Tylenol Has Been Established For Over 50 Years” with a link to Tylenol.com, indicating that the company has taken steps to attempt to protect its reputation. In 1982 it was thought that the cyanide poisonings would be the death of the company. Instead, their quick response was seen as socially responsible and doubts about Johnson & Johnson subsided. 2010 is a different story. In October Reuters reported disappointing quarterly revenue for Johnson & Johnson as sales plunged 25 percent. The number of recalls and the company’s slow responses to complaints signal some real problems within the company and public confidence is waning.

Still, the important news about Tylenol and the soaring numbers of other drug recalls in the US is not about profit/loss statements, it’s about drug safety. The corner drug store has always been seen as a place where we can find safe and reliable everyday remedies for common illnesses. If that is no longer true then we have to question the ability of the pharmaceutical industry and the FDA to keep us safe. The recalls have resulted in heightened scrutiny of certain drugs with hearings before Congressional committees. Tighter regulations requiring higher safety standards will help, but responsibility for safety begins with the consumer. Education about the drugs we take, including OTC drugs, is readily available on the internet and from the neighborhood pharmacist. That’s fortunate, because learning to question the medications we put in our shopping basket has become a necessary habit to create.       

 

Teenage “Pharmers”: Does Your Child Qualify?

I was a teenager in the 70’s, a decade when there was a lot of experimentation with illegal drugs. Many of the people I knew smoked marijuana. I didn’t personally know anyone experimented with more serious drugs but I heard the stories, like a party game called “Punchbowl” where guests brought prescription drugs and added them to a bowl so everyone could help themselves to the unidentified pills. Today the stakes are even higher because games like “Punchbowl” are more widespread. Renamed “pharming parties,” kids now raid the medicine cabinet to get high where my generation was more likely to raid the liquor cabinet. The number of abusers of prescription drugs has mushroomed even as use of illegal drugs, such as heroin and marijuana, has decreased, according to a report by Columbia University’s National Center on Addiction and Substance Abuse. The center says that about 2.3 million kids, 12 to 17, took prescription drugs illegally in 2003. That’s a whopping 212 percent increase from 1992.

The problem seems to be one of perception because in the 2009 University of Michigan Monitoring the Future Survey there were drops in tobacco, methamphetamine, cocaine, alcohol and hallucinogen use among 8th-12th graders. Teens now see certain drugs and alcohol as harmful and don’t believe these drugs are easily available to students anymore. Yet the increase in prescription drug abuse speaks to an attitude that “legal” drugs must not be harmful. After all, parents who may never touch street drugs are obtaining prescriptions for everything from pain to anxiety to lack of energy. Most commonly abused are central nervous system depressants like Xanax and Valium, opioids such as OxyContin, Vicodin and Demerol and stimulants like the popular ADHD drugs Ritalin, Strattera and Adderall.  

Most teens have a tendency to feel indestructible and immune to problems others experience. They will experiment because they don’t often see the link with their behavior today and the consequences tomorrow. It’s impossible to predict which ones will experiment and stop and which will develop serious problems. Problems of depression, family history of alcohol or substance abuse, low self-esteem, peer pressure, difficulty sleeping and aggressive and rebellious attitude toward authority figures are all warning signs of teenagers at risk for developing serious prescription drug dependency.

One answer may be as simple as locking the medicine cabinet. But because teens can obtain drugs from their friends, education is crucial. The subject of using pharmaceutical substances to treat medical and emotional problems must be an open subject within the family; parents must first understand their own prescriptions – what they take and why they take it. Kids need to understand that even though a drug may be legal, it is only safe when taken correctly and under supervision. Pharmacists can help; no one knows more about the medications prescribed to family members. With the information they provide the conversation can begin on the way home from the neighborhood drug store.

Non-Compliance: America’s “Other” Drug Problem

When thinking about drug problems in the US, illegal drug use or abuse of prescription drugs usually comes to mind. We probably think of non-compliance in our prescription drug regimen less often. But because non-adherence to drug treatment plans results in around 125,000 deaths and costs the healthcare system some $177 billion every year, it can be properly thought of as America’s “other” drug problem. For some time now pharmacists have been playing a larger role in our health care than they once did. While the physician may once have been the only one responsible for making sure drugs were taken correctly and on time, today’s “pharmacists are the medication experts and are specifically trained to help consumers with their medication issues and questions, including adherence.” Thomas Menighan, CEO of the American Pharmacists Association, also says that “pharmacists can help coordinate a better medication schedule and is available to discuss proper medication usage, food/drug interactions, side effects, dosing, generics and over-the-counter medications, compliance issues and more.”

Symptoms of taking medications incorrectly may not be noticeable or be as minor as a small headache and fatigue, yet may drastically alter the effectiveness of treatment and possibly be life-threatening. For example, patients with cardiovascular problems who do not adhere to their medications are at increased risk for stroke, heart attack and other cardiac conditions. In diabetics, improper adherence to medications and treatments can lead to debilitating complications such as increased blood sugar, amputations, blindness, kidney disease, cardiovascular disease and stroke. There can be many reasons people don’t take their medication as prescribed but because our healthcare model is changing, pharmacists are in a perfect position to take a more active role in alleviating this problem. Education and follow-up are key when consumers choose not to take a medication because they don’t believe in its value or its helpfulness or don’t take a prescription regularly because they don’t have a full understanding of the medication or the routine.

In a recent Harvard Medical School study, more than 20% of first time prescriptions went unfilled. Primary nonadherence, or the failure to fill a first prescription, was even higher among patients with chronic diseases – diabetes 31.4% and hypertension 28.4%. Any healthcare provider will tell you that medications don’t work in people who don’t take them. But since pharmacists also offer basic healthcare services such as blood pressure screenings and immunizations, education and compliance monitoring would seem to be a logical extension of the pharmacist’s responsibilities. In addition to the standard query, “Do you have any questions about this drug?” and the written instructions that are routinely given with each prescription, discussions regarding compliance should be customary. It’s common that physicians don’t do much drug education or follow-up with patients regarding how medicines are taken, how they work or how a patient feels once a regimen is undertaken. Making such discussions comfortable and convenient will go a long way towards improving the damage non-compliance does to our personal health and to our national healthcare budget.