A Tiny Tale of Retail

The Pharmacy and Therapeutics Journal published a survey study of pharmacist job satisfaction in 2004. It found that pharmacists in chain stores reported “significantly lower job satisfaction than their professional peers in other settings.” It also reported that those differences in job satisfaction couldn’t be explained by demographics or other measured factors. Further research, they say, would be needed to understand “which aspects of jobs in different settings are more or less satisfying.” Never mind. You boys run along now and publish another study on the effects of Viagra on ground-dwelling herbivorous apes. I just have to check the industry blogs for the inside scoop on the state of retail pharmacy. “We went to school,” wrote the Angry Pharmacist, “to end up using our deep pharmacological knowledge so we can apply it via AARP covers Zocor and not Lipitor…Lyrica is only covered if Neurontin is failed and nobody covers f*#^ing Adipex-P or Xenical. We wait on hold to speak with some dillhole in India who speaks like a robot because the ID card has the wrong information or PCN printed on it. Take it and like it; you don’t have a f*#+ing choice anymore.”

Hmmm……
CVSsucks.blogspot.com says CVS sucks. Pharmacist blogger Jim Plagakis says, “This profession sucks.” Costcowebpharmacy.com says the Costco pharmacy sucks. The suckreport.com declares, “Yes, retail pharmacy sucks.” The Angriest Pharmacist must surely think retail pharmacy sucks, ergo the blog name “The Angriest Pharmacist.” Retail-sucks.com says all retail sucks, including pharmacy. The cafepharma message board states that retail pharmacies do indeed suck and as a result pharmacists also suck. Blogger Drugmonkey wrote a book entitled, “Why Your Prescription Takes So Long to Fill: A Foul-Mouthed, Liberal  Pharmacist Breaks the Curse of Christmas and Strikes Back Against the Ideological Forces That Threaten the Profession He Grudgingly Grew to Love.” Oh, yeah. Drugmonkey thinks retail pharmacy REALLY sucks.

Remember when you could get good service? When you could go to a hardware store and instead of some mouth-breathing high school dropout, a nice, middle-aged employee would greet you at the door? This was his CAREER. He could actually explain the benefits of a fiberglass- handled hammer over a wooden or steel-shafted one. I remember when an attendant pumped gas for you. I remember sitting down in a shoe store and yes, actually being fitted for shoes. I remember when my doctor took the time to have a discussion with me. And I remember the corner drug store where I could sit and have a soda while I waited for my prescription, get a recommendation for the best thing to use on a sunburn and then be told that since there would be a bit of a holdup on my pill refill, would I like it delivered to my house later today? Jeez. Those were the days. Where did they go?

American businesses are engaged in one big race to the bottom these days. The lowest price. The cheapest ingredients. The skinniest labor margin. Sure, everybody likes a bargain. But everybody also likes products that last. That are safe. Effective. Correct for the individual and the situation. In a race to the top kind of scenario, quality goods would be manufactured, sold and serviced by quality employees whose expertise and dedication to the clientele would be rewarded with a healthy paycheck and good benefits. Instead, we go to concrete warehouses to purchase cheap, plastic crap manufactured in foreign sweat shops sold to us by McEmployees who work for the same wage I got paid in 1979 and have no idea what the advantages of LCD over plasma may be. And don’t care. What that translates to at your local Walgreen’s or CVS store is some $4.00 prescriptions rung up by clueless pharmacy technicians overseen by disillusioned pharmacists. No compounding. No education. No counseling. No delivery. No service.

In the latest edition of Drug Topics, an e-zine for drug professionals, pharmacist Oluwole Williams comments that “public perception of the role of a pharmacist is somewhat distorted, especially when examined beside the pharmacist’s expectation of how he desires to be seen by patients.” No doubt. A dumbed-down public with low expectations and on the hunt for the next deal just wonders what the hold-up at the drive-thru is. How long can it take to get me that cream, anyway? Isn’t it already in the tube?

Pharmacists are drug experts. They went to school for a long time and have the loan payments to prove it. They may work the pharmacy counter at Costco, between the baby diaper aisle and the potato chips, but they are still the best resource you have when it comes to understanding the prescription drugs that can save your life. Or kill you. They should be seen as professionals – as providers of safe, affordable, effective medicines, counselors on the side effects, adverse events and possible interactions between the remedies we take, the source of supplements and safe medical appliances, contributors to public health issues, gatekeepers of prescriptions and poisons and overseers of the potentially hazardous mass-circulation of pharmaceutical drugs.

Retail pharmacies suck because retail corporations and insurance companies don’t care anymore about providing quality services and products. Like everybody else, I love to rag on the corporations – the Exxon’s and ATT’s of the world who wreck the environment, lobby Congress for sweet tax deals, pay their CEO’s 400 times what they pay their employees and export jobs to China for 25 cents an hour. And they deserve our criticism. But as the employees who work for them and customers who buy from them, we have to take some of the blame for what’s happened to service in this country. After all, we let them get away with it. Every day that we don’t complain to management, call our government representatives and professional organizations, or make another purchase at WalMart is a day corporations get away with providing cheap products, terrible service and rotten labor practices.

Come on, people. Your sense of outrage is slipping. Pull your pants up.

Scratch My Back and I’ll Scratch Yours!

A friend of mine wrote to me this morning – “My skin is driving me crazy with itching. The doctor gave me a prescription, but I still itch. I remember you mentioned you use something really good for dry skin. Could you please tell me what it is?” Now I’m not a pharmacist or a doctor. I don’t even play one on TV. But after 55 years on the planet and lots of health challenges of my own I have learned one thing: medicine as it is practiced in the US is great if you’ve suffered some kind of trauma or have an acute illness. Otherwise, approach with caution! I called my friend. “What did your doctor prescribe?” I asked. “Cortisone cream.” “Did she tell you why?” “Well, she said I have dry skin. But it’s strange. Only my hands and forearms itch, and sometimes they itch so bad that I scratch until there’s a blister.” So we discussed cleaning products and pet products or any and everything else she may have gotten her hands into that could have caused the itching. There’s been no chemical contact she is aware of. No allergies. But her doctor prescribed hydrocortisone cream and I wondered why. “Does the cream help?” I asked. “For a little while.”

Itchy skin is one of those broad, grey areas that physicians hate because there is no single-bullet approach to curing it. There must be a hundred things that can cause it – some serious, but most not. The worst thing that might happen to you is getting caught scratching with your fork at your spouse’s black-tie business affair. Most doctors don’t think too much about it. They don’t know why you have it, either. Write out a prescription for hydrocortisone cream – the ubiquitous skin remedy. Case closed.

Hydrocortisone is a “steroid hormone produced by the adrenal cortex and used medicinally to treat inflammation resulting from eczema and rheumatism.” It’s used to treat insect bites, poison oak/ivy, eczema, dermatitis, rashes and itching because it reduces the swelling, redness and inflammation that can occur in these types of conditions. Sounds good, so far – yes? But the small print on the packaging may cause you to think again. It’s not to be used on the face or underarms. It cannot be used as needed – only up to 4 times a day. And it shouldn’t be used long-term. Steroids are serious business, even topical ones. They can cause thinning and discoloration of the skin, easy bruising, permanent dilation of certain blood vessels, “burn” marks on the skin, dermatitis and itching (wait a minute, wasn’t itching the reason it was prescribed?!), kidney or liver damage and worse. The skin on the face, underarms and groin is thinner than other places on the body, yet are all places where eczema, rashes and allergic rashes are particularly common. Where the skin is thin, topical medications tend to penetrate more deeply. Once steroids hit the bloodstream they can cause all kinds of havoc, so you really shouldn’t put the cream on those areas. But if your doctor prescribed it you’ll probably put it there anyway and hope for the best. Oh, and if it only kind of helps, as in my friend’s case, you may also disregard the warning to only use it for a maximum of 7 days. Topical steroids can also be purchased OTC and overuse can cause the skin to develop a resistance (called tachyphylaxis) to the medication. As a result, in order to have the desired medical effect, a stronger and more potent steroid may be needed, which may cause even more potential side effects. Call me crazy, but something’s just not right here. The diagnosis was dry skin and dry skin is a chronic, not acute condition like poison ivy or a bee sting. So why prescribe something that should only be used for 7 days? One woman who used cortisone cream long-term had this to say about it: “When I was using this cream I thought it was great. It always seem to clear up my eczema on my face and hand, but now after using this cream for years I’ve discovered it’s the cause of the brown rings and wrinkly condition around my eyes. So I’m dumping all my creams and I’m going to kick my doctor’s ass.” Yeah. And don’t forget your steel-toed boots.

Don’t get me wrong. Topical steroid creams definitely have their place, especially in acute situations where inflammation is involved. But any physician prescribing it for chronic conditions is either lazy or ill-informed. Or both. There are SO many others approaches to dry skin one can take other than resorting to a topical steroid. Lotions can help temporarily, but can actually cause the oil glands to produce less natural moisture when the situation calls for more. One simple solution is to make sure to drink enough water. Eight glasses a day keeps skin hydrated and flushes out toxins. Use a good sunscreen and block out damaging UV rays. Wear gloves when working with household chemicals that rob the skin of oils and moisture. Use a humidifier in the winter when furnaces dry the air and the skin.

What we eat has a definite effect on the skin’s health. Omega-3 fatty acids support the skin’s lipid layer and help it hold in more moisture. As we age we need to make sure we get enough. Lots of foods are high in fatty acids, like salmon, flax seeds and walnuts. Eating one ounce of walnuts per day is said to have a healing effect on the skin for some in as little as two weeks. And fatty acids can also help with depression,
fatigue, Type-2 diabetes and joint pain. If you’re not fond of nuts and fish, or even if you are, consider taking 500 mg of black currant seed oil every day. Black currant seed oil is an excellent source of GLA (gamma-linoleic acid), which the University of Maryland Medical Center lists as an essential fatty acid used to treat a variety of ailments. Dr. Andrew Weil, a practitioner of both traditional Western and natural medicine, says black currant oil “offers a wide range of benefits, from acting as an effective anti-inflammatory agent (with none of the side effects of anti-inflammatory drugs) to promoting the healthy growth of skin, hair and nails.” I started using it years ago, when swimming pool chemicals were turning my skin into something resembling alligator hide. It works.

We are, sadly, an instant-fix society. I am just as annoyed as anyone else when my computer doesn’t change pages right NOW! But I’ve learned to carefully consider every prescription my doctor writes for me. “Get a high-quality lotion like AmLactin to use on your hands and arms in the interim,” I said to my friend, “because black currant oil takes about 6 weeks to kick in. But if what you have really is dry skin, you can kiss that tube of cortisone goodbye.”

Please Pass the Tissues – Then Shoot Me

Drip. Wipe. Blow. Sneeze. Repeat. This seems to be the reality of many of my neighbors here in the state of New Mexico. As I peruse the bedding plants and sacks of fertilizer in my local home store I shuffle my feet to the “Hack, hack, tweet, tweet!” of the Springtime Serenade. Red eyes and noses appear above the shelves of fish emulsion and snail bait while multi-colored handkerchiefs flap in the dusty breezes of the garden department courtyard. Ahh! It’s another beautiful May in the desert. Allergy-ridden horticulturists, hell-bent on having beautiful yards, no matter what the cost, stuff their SUV’s with the bags, buckets and boxes of their unfortunate demise: flowers. Grasses. Trees. POLLEN!  

 Checking the pollen count for Albuquerque I find the count for trees is – HIGH! The forecasted pollen levels for trees is – VERY HIGH! Summer is just around the corner. Those HIGH! pollen levels for grasses are sure to follow. And then we have VERY HIGH! pollen levels for weeds to look forward to! Would-be gardeners will honk, wheeze and scratch themselves to the corner drug store, creating a bonanza for the makers of allergy remedies like Zyrtec, Allegra and Claritin. Irritants like grass and tree pollen stimulate the immune system to release histamine, causing the familiar itching, sneezing, runny nose and watery eyes. According to the American Academy of Allergy, Asthma and Immunology, seasonal allergies result in 12 million physician visits a year and $11.2 billion spent on treatment. No wonder. Seasonal allergies are miserable. People who suffer from them will do nearly anything for relief. A friend of mine from my college days has terrible allergies. She appears to have a cold all the time. A really bad cold. We graduated from college in 1978. If I had had a really bad cold since 1978 I would be swallowing every pill and potion I could get my hands on for some relief. There are all kinds of medications on the market; some 35 are available OTC, another 28 by prescription. There are antihistamines, decongestants, anticholinergics, corticosteroids, leukotriene modifiers and mast cell stabilizers. There are sprays, drops, pills, and liquids. Some can raise blood pressure, cause insomnia or drowsiness. Others may cause diabetes, osteoporosis or glaucoma, lead to skin rashes, fever, heartburn and headache.  But according to a 2005 survey conducted by the Asthma and Allergy Foundation of America, more than half of respondents said they were “very interested” in finding a new medication. One in four reported “constantly trying different medications to find one that works for me.”  Why is it so hard to find an effective treatment?

Allergic rhinitis, or hay fever, as it is commonly known, isn’t taken very seriously, either by physicians or allergy sufferers themselves. There are 50 million people in the US with allergic symptoms severe enough to warrant treatment, but four out of five never make it to the doctor. Instead they rely on OTC remedies. A patient may try one antihistamine and if it doesn’t work try another, when what they really need is a decongestant, or a drug that targets another part of the allergic reaction or a steroid. There’s no treatment plan in place and they suffer needlessly. In reality, seasonal allergies are nothing to sneeze at. Allergies can lead to sleep problems and set sufferers up for more serious respiratory problems. Children with allergic rhinitis are three times more likely than their non-sniffling counterparts to develop asthma. Kids and adults alike are more likely to develop sinus and ear infections, especially if their allergies go untreated. There are lots of medications these days that can help and some of the newer ones have few side effects. And there are things people can do to lessen their need for medications or even do without them altogether. The following steps can lead to a reduction in the irritants that cause allergic rhinitis:

1.      Check your local pollen forecast. See what kind of allergens are in the air as temperatures get warmer.

2.      Try to make your bed as allergen-free as possible. Dust mites (eww!) hide in old bedding and mattresses. Vacuum your mattress. Use a mattress cover. Wash and replace bedding often.

3.      Get rid of the carpet. Have you ever taken up an old carpet and seen what’s underneath? Believe me, you don’t want to be breathing that stuff. Hard floors are much easier to keep clean.

4.      Wear big sunglasses. Do your best Jackie O impression. On a windy day you’ll keep pollen out of your eyes.

5.      Give your pup a bath. Your cat, too. You’ll keep their dander down and have less dirt in the house.  

6.      Exercise in the evening. On high pollen days you can choose to run, walk or bike in the evening, when counts are lowest. Shower when you come in.

7.      Use HEPA filters. High-efficiency particulate air (HEPA) filters can be used on vacuums and vents. They trap allergens.

8.      See your allergist. He can dig deeper if OTC or home remedies don’t help. You may need a prescription drug or even allergy shots.

One more thing – I’ll let you all in on the miracle potion that helped with seasonal allergies around my house. My significant other was truly suffering from a dry, allergic cough which made existence generally wretched. So I did a little research on home remedies and rediscovered a tried-and-true concoction: a nice cup of chamomile tea with some fresh lemon juice, some raw, local honey and a wee bit of bourbon. It’s worked wonders. Just sayin’.