You, Robot.

I was working at my desk one day when I heard my boss come into the lunch room and put his feet up on the table. “Man,” he said, “I sure could make a lot of money if I didn’t have to pay my employees!” All munching and wrapper-rattling ceased for a moment. I mean, what do you say to that? Nobody runs a business all by himself. A person may act as a leader or the creative force behind a product, but it takes a team to turn someone’s ideas into reality. Aside from a whole lot of stupid in the boss’ comment there was an even bigger dose of arrogance. But this was the 80’s, an era of union-busting, easing of child labor and anti-sweatshop laws, cutting of job training programs and replacement of thousands of federal employees with temporary workers who would not have civil service or union protections. A decade of anti-labor legislation and rhetoric would set the stage for the current situation of wage stagnation, loss of pensions and benefits, off-shoring of jobs and unemployment.

Fast forward 25 years to 2011. The governors of New Jersey, Wisconsin and Ohio all fought to abolish collective bargaining rights and limit health insurance benefits, sick leave and vacation time for public workers. The governor of Maine removed a mural from the Department of Labor that depicted the history of labor in his state. The governor of Texas claimed he worked a “Texas Miracle” in employment, which turned out to be a lot of low-wage positions without health insurance or other benefits. The governor of Michigan is being sued over legislation which bans labor agreements in construction projects paid for by the state. The governor of Florida supports legislation to block state and local government from deducting union dues from employees’ paychecks, making it harder for unions to collect operating funds. Within three months of taking office, the governor of New Mexico had five suits filed against her for firing the entire Public Employee Labor Relations Board which enforces public sector bargaining rights and handles disputes. So would you be surprised if I told you that Slate Magazine recently reported on the growing trend of replacing pharmacists with robots? Me neither.

Whatever your view regarding unions, they set the bar for wages and benefits for workers across the nation, public and private. When unions are weakened, wages drop and benefit packages shrink. Workers are being vilified to justify paying them less, as in New Jersey where the governor referred to teachers as “thugs”. Professions held in esteem when I was a kid – teachers, firefighters, cops, nurses and civil service workers –
are no longer seen as valuable. There are fewer of them and they’re paid less. If you think pharmacists aren’t vulnerable to the same kind of treatment, think again. The trend in pharmacy is away from service-oriented community drug stores and toward the big chain model where the emphasis is on filling prescriptions – lots of them – and little else. Pharmacists don’t have time to do anything else. They have about 3 minutes, on average, to correctly check and fill each one. More often, insurance companies are referring their customers to mail-order pharmacies where face-to-face interaction is cut out altogether. The PharmD degree has become the education standard but practicing retail pharmacists don’t have the opportunity to use their clinical training on the job. Pharmacists are marginalized, their skills underutilized. Although, as Slate reports, pharmacists spend “years learning about the deep connections between pharmaceuticals and human biology”, most of that training isn’t used on the job. Instead, they spend their time on more menial tasks – calling doctors, checking on insurance coverage and dispensing medications. Much of their job is repetitive and that, according to Slate, makes them ripe for replacement by robots: “Most major retail chains also operate “central fill” facilities—huge, automated plants that crank out thousands of prescriptions and send them out to all the stores in a particular region. More than likely, the pharmacist who hands you the medicine played no part in dispensing it.” And robots are more accurate than humans, with automated mail-order operations making one mistake for every 1000 prescriptions filled vs. one error for every 55 filled at a retail pharmacy.

The Redheaded Pharmacist, whose blog I read regularly, disagrees with Slate’s opinion that robots will eventually take over: “Forgive me if I find it hard to believe a robot will….help an old lady with exactly 18 questions about stool softeners. And I didn’t even talk about other functions of pharmacists like compounding, dose adjustment calculations, answering clinical questions, and of course flu shot administration. If we really are at risk of being replaced by machines then the position of pharmacist has been marginalized to the point where we don’t matter anyway.” And that’s exactly the point. Professionals of all stripes ARE being marginalized and marginalization, at least in the case of pharmacy, will lead to automation. Forget the fact that pharmacists spend a lot of their time straightening out insurance snafus and keeping people informed. Lack of service is already the problem most complained about by mail-order pharmacy customers. As robots are phased in, pharmacy customers will have fewer and fewer resources available when they have problems or questions.

The Redhead is right when he says that pharmacy is at a crossroads. If robots can dispense better and retail employers aren’t interested in pharmacists playing a bigger role in their customers’ medical care as counselors and educators, then it’s up to pharmacists to get serious about carving out a niche for themselves. They can do a lot to improve medication adherence, reduce complications, monitor and adjust drug regimens
for chronic conditions like HIV and cancer, administer vaccines and educate the public on the drugs that are prescribed for them. Pharmacists can fill the ever-widening gap between health providers and those with little or no insurance coverage, but first they have to overcome this image of pharmacist-as-pill-counter that persists in the minds of employers and patients. In this environment where workers have less respect than ever, pharmacists must demonstrate their value to the community. Tomorrow when you call an airline or a credit card company and can’t get an actual person on the line, you will be reminded of one thing – the human factor is vital. The lack of it is what is wrong with American business, including health care, today. Pharmacists have to show management that strengthening the human connection is actually good for business. As Karel Capek, the Czech author who popularized the term “robot” said: “Robots are mechanically more perfect than we are, they have an astounding intellectual capacity, but they have no soul.”



Pain Medications – Seeking the Middle Way

If you’ve ever suffered from chronic pain, you probably have an opinion about pain medications. Years ago an illness drove me to the emergency room repeatedly for pain that was so bad I couldn’t think. Because my problem wasn’t easy to diagnose, the staff began to treat me as a “drug seeker”, someone who feigns illness in order to score pain medications. When I was finally admitted to the hospital the skepticism continued, with one doctor threatening to discontinue my pain meds altogether, saying I was becoming addicted. Some social work friends of mine finally threatened to bring a Medicare review against the hospital if I didn’t get what I needed – a consult with a pain specialist and the right combination of drugs. After this experience I’m always surprised at the number of private physicians who seem happy to pass out OxyContin and Vicodin like M&M’s. “Opioids,” according to the U.S. Food and Drug Administration (FDA), “are at the center of a major public health crisis of addiction, misuse, abuse, overdose and death.” Since physicians are prescribing the stuff it makes sense that possible solutions to the problem should come from physicians. As a favorite teacher once said to me, “You got yourself into this mess. You’re the one who has to get yourself out of it.”

Opioid medications consist of any of several synthetic compounds, such as methadone, which have effects similar to natural opium. The analgesic effects come from a decreased perception of and reaction to pain as well as increased pain tolerance; their popularity as recreational drugs comes from their ability to produce a feeling of euphoria. A study published in the British Medical Journal in August of this year supported a limited
need for opioid medications and noted that the number of deaths in the U.S. involving them grew from 4041 in 1999 to 14,459 in 2007. That’s more common than deaths from multiple myeloma, HIV and alcoholic liver disease.

When it comes to these deaths, at least two physicians have decided it’s time to do something. An oncologist in West Virginia, Dr. Hassan Amjad, and his colleague, Dr. Hassan Jafary, have formed the West Virginia Advocacy Group to help curb the problem of prescription opioid abuse by gaining refusals by other physicians to prescribe them. Through the advocacy group, volunteers circulate an agreement among area physicians. Line one of the agreement reads: “I do hereby pledge that no prescriptions for oxycodone will be written by me for any patient.” Dr. Amjad is asking other physicians to agree that, “Yes, we see the problem, we see young people dying. We will not write these medications.” Amjad believes that only patients with terminal illnesses, and not all of those, should take OxyContin or its various formulations and that physicians are not careful in prescribing them. He believes that giving them to patients with benign conditions such as arthritis or back pain is contributing to the drug problem in southern West Virginia. “There are patients who had foot surgery 10 years ago and are still getting these pills,” said Amjad. “Even as an oncologist, I am saying there is very little need for oxycodone and Percocet in treating patients. There is no way that a patient without a terminal illness needs these medications,” he told the Register-Herald, a West Virginia newspaper.

Sounds reasonable, right? Yet many believe that refusing the drugs to all except terminal cancer patients is a one-solution-fits-all approach with serious implications for patients with chronic pain. To them, describing arthritis and back pain as “benign” is not only ridiculous, but offensive. Both conditions can turn a person into an invalid, making the decision for a doctor to “never” prescribe them seem unreasonable. An argument can be made that a majority of the deaths involving opioids from 1999 to 2007 involved methadone and only a small percentage from oxycodone itself. In other words, drug addicts who receive methadone treatments for addiction and overdose from a combination of methadone with alcohol or other drugs drive up the statistics. Pain, according to Jeffrey Fundin, Associate Professor at the Albany college of Pharmacy, is the single most common reason for seeking medical care. Some 9% of American adults suffer from severe non-cancer pain. More than 50 million Americans are partly or totally disabled by pain, yet 40-50% of patients don’t receive adequate pain relief. Opioids, when used properly, are a very effective pain treatment, especially for people who can’t take non-steroidal anti-inflammatory drugs (NSAID’s) like Ibuprofen. While some doctors prescribe them inappropriately, others shy away from them for fear of patient addiction and side effects and their own disciplinary action or prosecution. Proper pain management is crucial, not only for chronic conditions but also for surgeries, injuries and the elderly. Dr. Amjad’s crusade to persuade doctors to stop prescribing opioids is like Prohibition in the twenties, when solving the country’s alcohol problem was going to be solved by taking it away from everyone.

Pain medicine is a specialty field – non-specialists tend to have limited knowledge on the subject. A neonatal intensive care nurse I know is always surprised at the narrow approach to pain management that physicians take on her unit. Their tendency is to fall back on a few drugs which tend to anesthetize the infants. Nurses find that multi-prong approaches to pain management are more effective, such as a combination of Tylenol, Versed (a benzodiazepine) and swaddling the baby tightly to make them feel secure. Physical therapy, chiropractic treatment and massage, nutritional supplements, biofeedback, acupuncture, stress management, exercise and diet have been found to be effective alternatives but many physicians are either ignorant of or hostile towards using mind-body therapies alone or as adjuncts to pain medications. Opioids are powerful weapons against pain but doctors have an entire arsenal they can choose from. When it comes to the subject of their use or misuse perhaps physicians should consider the middle way and moderate between the extremes of potentially dangerous, addictive chemical treatments and nothing at all.



Autumn: The HPV Vaccine and a Rousing Game of Political Football

I went to see “Contagion” last weekend, a film about a fast-moving airborne virus that kills within days and voraciously chews at the edges of the social fabric. After the movie the prevailing comment in my group was that it was “simple”. It didn’t follow, in other words, the formula of some of the other pandemic disaster flicks we’ve seen – no zombies, no aliens, no ridiculous plot premises. Indeed, in an interview with Movies Online, director Steven Soderberg discussed that it was “the right time for an ultra-realistic movie about this subject.” Much of the film examines the role of the government in managing such a crisis. Against a contemporary backdrop of the anti-government Tea Party movement in the U.S., Soderberg considers the problems of the Federal bureaucracy: 50 different state health policies, cronyism, social media pressures, quarantines, curfews, law enforcement and the inevitable main character in all epidemic films – the vaccine.

Vaccines are a controversial subject in this country. We love ‘em and we hate ‘em. Certainly in a crisis like the one in “Contagion” all eyes would be on the government to develop a vaccine to stop the virus. But outside of an emergency situation we have the luxury of time in which to examine the implications of vaccines. Their profit potential, safety and effectiveness, effect on the immune system, adverse side effects and civil rights implications are all subjects that give us pause when asked to roll up our sleeves. And so they should. Vaccines are a matter of life and death, big money and political influence. They should not be taken lightly. So when Michele Bachmann, GOP candidate for the presidency, alleged that human papillomavirus (HPV) vaccine causes mental retardation in children, the pot of fear and loathing that is the vaccine controversy in America got a great, big stir.

HPV is the most common sexually transmitted disease in the U.S. The CDC says 50% of all sexually active men and women will get it at some point and that 20 million already have it. Most HPV infections go away on their own but some result in cervical cancer, the second-leading cause of cancer deaths in women worldwide. The American Cancer Society says that of the 12,000 cases of cervical cancer this year, the majority will be HPV-related. The virus is also increasingly implicated in vaginal, vulvar, penile, anal and head and neck cancers, an estimated 24,000 cases per year. A national debate exists about whether to head off the effects of the virus by requiring girls to be vaccinated before they become sexually active to allow the vaccine to work to its fullest potential. In 2007 the governor of Texas, Rick Perry, signed an executive order requiring all
sixth-grade girls in his state to receive the vaccine. The order had an opt-out option for parents who didn’t want their daughters vaccinated but still the order was not popular; the state legislature overrode it in 2008. In the recent GOP debate Perry took a lot of heat for signing the order. Minnesota Representative Michele Bachmann has been particularly vocal about the issue, calling Perry’s mandate “flat-out wrong” and saying she felt “offended for all the little girls and the parents that didn’t have a choice” in the matter. After the debate Bachmann told NBC’s “The Today Show”: “I had a mother last night come up to me in Tampa after the debate. She told me that her little daughter took that vaccine, that injection, and she suffered from mental retardation thereafter. It can have very dangerous side effects.” Really? Michele Bachmann has decided that the vaccine is dangerous, then scared parents half to death with allegations that it causes mental retardation based on the anecdotal evidence of one person?

There are two vaccines that have been approved to protect against the cancer-causing strains of HPV, Gardasil and Cervarix. Each is given in three doses over a six month period. The vaccines can prevent most cases of cervical cancer if a woman has the vaccinations before she has been exposed to the virus. Therefore, the CDC recommends routine vaccination for girls who are 11-12 years of age. Even so, the CDC says that less than half of girls have gotten one dose and less than one-third have gotten all three doses. About two-thirds of teens receive their shots for meningitis, tetanus, diphtheria and whooping cough. Not only is mandating the vaccine unpopular, it would seem the vaccine itself is disliked. Maybe the cost has something to with it – the vaccine costs about $400 (It’s usually covered by insurance) and there is the matter of having to get three doses of the stuff. But more than likely, concerns about sex are the biggest factor. Eyebrows may rise because the vaccine works best before a girl is sexually active and these days that means 11 or 12 years old. Parents may worry that promoting the vaccine at such a tender age will cause their daughters to become sexually curious before they’re ready. Perhaps, as is true with sex education and birth control, people fear the vaccine will make kids think that sleeping around just got a little safer. The message about the vaccines may truly be about protection, not promiscuity, but for some parents the word “promiscuity” rings much louder. As for requiring the vaccinations, the American Academy of Pediatrics (AAP), the CDC, and the American Academy of Family Physicians all recommend that girls receive HPV vaccine around age 11 or 12, yet some individual members of the organizations are philosophically opposed to mandating it. But other vaccinations ARE required. Should the HPV vaccine be treated as a special case because it protects against a sexually transmitted disease instead of an airborne one? The recommendations for use of the vaccine, based on scientific data, including safety studies, indicate that the benefits of HPV vaccines far outweigh any of the known risks. The safety record of these vaccines is excellent. After five years and more than 35 million doses of HPV vaccines given, all of the available scientific evidence shows that HPV vaccines are safe and effective, and provide the best opportunity to prevent HPV infection and its consequences.

There will continue to be controversies and questions in this country about vaccines of all kinds, to be sure. They center on the health and well-being of our kids and as such they are hot-button issues, often viewed with suspicion and emotion. This being obvious, public figures need to be careful what they say about them instead of using them to score political points. In the future it would be nice if the Michele Bachmann’s of the world would verify the existence of flames and smoke before yelling “Fire!” in a crowded theatre.



The FDA: Friendly Neighborhood Watchdog? Or Big Pharma Lapdog?

The other day a friend of mine, a nurse, by the way – touted the benefits of a weight loss remedy that has helped her to lose 31 pounds. Confident in her results, the only drawback she saw is that the drug was manufactured in China. Faces around the table fell. Manufactured in China: melamine poisoning and lead contamination. No, thanks. “But when you think about it,” I commented, “you don’t have to go to China to get tainted drugs. We have plenty of unsafe drugs right here in the good, ‘ol U.S. of A.” Turn on the tube and you see some drug maker pushing a new pill; turn the channel and there’s a lawyer suing over its adverse effects. It’s the job of the FDA to ensure that drugs released to the market are both safe and effective. But when it comes to the approval of pharmaceuticals, half of the medical evidence concerning them is hidden – the evidence that the drugs don’t work. Drugs just aren’t policed as they should be because the FDA and U.S. drug companies make very cozy albeit very strange bedfellows. Never mind the “U.S. Food and Drug Administration,” a more accurate description of the FDA might be “Federal Drug Aid”.

No government agency can operate effectively when there is a revolving door between it and the industry it is supposed to regulate. But in America the door of separation between the FDA and Big Pharma is turning 24 hours a day. A survey released by the Consumer Reports National Research Center in 2007 showed that 84% of us think that drug companies have “too much influence over the government officials who regulate them.” Over two-thirds of us are concerned over the fact that drug companies actually pay the FDA to review and approve their drugs. (Americans know their stuff, it turns out. When drug studies are funded by drug companies, positive outcomes are found at a rate of 4 to 1 over independent studies.)

92% of those surveyed agree that pharmaceutical companies should disclose the results of ALL clinical trials, not just the positive ones they want to advertise. Drug companies have buried negative drug trials and the FDA has been caught conspiring with drug companies to conceal negative drug data from the public. (To combat this, the scientific journals banded together in 2004 and refused to publish data from any drug study that didn’t publish results from all trials, positive and negative, on a central database. But listing obscure, unpublished trials in a hard-to-navigate database run by the National Institute of Health is hardly useful public disclosure.)

60% of survey respondents agreed that doctors and scientists with a financial conflict of interest should not be allowed to serve on FDA advisory boards. Doctors who earn thousands of dollars in “consulting fees” from drug companies are not only allowed to vote on recommendations for FDA approval of their drugs, there is not even any FDA requirement to disclose such conflicts of interest. (To further muddy the waters, salesmen or researchers funded by Pharma present findings at conferences funded by Pharma using presentations prepared by Pharma….!)

To put the survey results into perspective, consider cholesterol. Because a cause and effect relationship between high cholesterol and heart disease is pretty much the prevailing wisdom in medical circles, the drug industry makes a whopping 40 billion dollars a year in sales of cholesterol-lowering medications. But here’s an interesting twist: the cholesterol-lowering med, Zetia, speeds progression of heart disease DESPITE lowering cholesterol when combined with Zocor, a statin drug. This startling finding sets the drug business on its head, according to physician and four-time NY Times best-selling author, Dr. Mark Hyman, because the question of whether or not cholesterol causes heart disease was supposed to be settled. Physicians have come to believe that high cholesterol causes heart disease because the studies pushed forward by the drug industry tell them so. Statin drugs block the formation of bad cholesterol, or LDL, in the liver, but it turns out that statins actually lower risk because of a side effect not known about until after the drugs were released – they also lower inflammation. Harvard physician Paul Ritger found that heart attack risk is lowered only if c-reactive protein levels in the blood are lowered along with LDL, not just by lowering LDL levels alone. C-reactive protein levels rise in response to inflammation. Zetia was meant to be paired with cholesterol-lowering drugs like Zocor or Lipitor in order to lower cholesterol even more. The FDA released Zetia without any proof that it prevented heart attacks or reduced the progression of heart disease, but only with the idea that it lowered cholesterol and that lowering cholesterol was a good thing. It was given to 5 million people and made the drug companies about 5 billion dollars a year. That’s almost 14 million dollars a day, so when Zetia was released the drug companies had no incentive to conduct studies to prove it does what they say it does – reduce the risk of heart attack. Only after two years of foot-dragging and pressure from news agencies and Congress were the studies done and the negative data released. The FDA had the data. The question is why didn’t they speak up? Once the bad news hit the media the American Heart Association said the study about Vytorin, a combination of Zetia and Zocor, was too limited to draw a conclusion about its ability to prevent heart attacks when compared to Zocor alone. They released a recommendation that patients not stop taking Vytorin without consulting their doctors. But what they didn’t say was that they had received 2 million dollars in funding from Shearing-Plough & Merck, makers of Vytorin. The study showed that Zetia did not lower the risk of heart attack and increased fatty plaques in the arteries despite lowering cholesterol. Let that sink in for a moment. Lowering cholesterol led to more heart disease and turns our whole medical model upside down. High cholesterol, in other words, is not a disease.

What we have in America is a research mess that is flawed in 3 ways: 1. What gets studied depends on who’s paying for it, so drug companies don’t pay to study therapies that might work better, like diet and exercise. 2. Drug companies, aided by the FDA, suppress, hide or do not publish negative studies, only positive ones. This leads physicians to believe that the studies provide actual evidence instead of corporate propaganda. 3. Doctors and patients believe they have the truth even when it’s too late. The data is there but no one publicizes it.

What to do when it seems like you just can’t fight City Hall? Follow the money. Be suspicious of any study funded by drug companies. Call your representatives in Congress and demand better legislation regarding easy navigation of a database of all drug trials with user-friendly summaries of published and unpublished data submitted to the FDA. Everyone should be able to look up any drug to get balanced opinions regarding it. Finally, don’t assume that a prescription drug is the answer to your health problem. Many illnesses are the result of your lifestyle interacting with your genes.  Learn to ask, “Why?” and search for the answers. Lifestyle choices can do much to help us prevent or cope with illness. Ask your doctor to try everything else first. Then insist that the drug companies put prescription drugs where they belong – in the back-up position.

You Want Me to Take What?!

The neighborhood drug store – all white coats and medicine bottles. Sticky potions that stimulate the gag reflex and bitter pills that get struck on the way down. Prescriptions and illnesses and medical insurance gobbledygook. Dull, dull, dull. But beneath that polished professional veneer things are not as they seem. Seriously, you gotta love an industry with a remedy that treats your Parkinson’s Disease AND gives you an uncontrollable urge to head to Las Vegas and gamble away the mortgage check! So step right up, folks and don’t be shy! Behind this curtain is the strange and unexplainable, the weird and whacky, the curious, creepy world of pharmacy!

Humans are strange creatures. They spread fish eggs on toast, bury eggs and then dig them up for dinner four months later, pick fleshy nodules from under trees for the spaghetti sauce. But scraping the leavings from Sardinian sewers to use on bacterial infections is the very definition of “strange”. Yep, that’s where cephalosporin comes from – the pipes under Nonno Renzo’s house! Really, you have to wonder at the minds who thought to use horse urine to ease menopause symptoms or Gila monster venom to treat diabetes. One explanation of the pharmacist’s symbol “Rx” is that it was derived from the Latin word for recipe, meaning, “Take, thou.” But if anyone offers me a nice plate of rooster’s combs for my lumbago, well, maybe I’ll try a heating pad instead…..

Lots of remedies not only have strange and weird origins, they also do strange and weird things to you once you take them. You might, for instance, have your doctor’s prescription for Raptiva filled, hoping to be relieved of your psoriasis symptoms. One small problem:  Raptiva can cause “new or worsening psoriasis!” Taking Boniva to strengthen your bones? It can weaken your femur and cause it to break. If a broken bone depresses you, take some Celexa. Once you start taking it you may feel like committing suicide – problem over! You know, you don’t have to have a prescription to have weird drug symptoms – you could just have a lot of heartburn and drink a lot of that pink stuff and wind up with a black, hairy tongue. No need to look it up, the visual on this one suffices. Speaking of hair, Propecia treats hair loss in men. Lots of men may want their hair back because they think that a full head of hair is sexy, except Propecia, sadly, shrinks their….man berries. So if there’s hair in the sink don’t think Elmer Fudd – think Shemar Moore!

Zoloft, Ambien, Mirapex, Raptiva, Actonel, Avodart, Celebrex, Boniva! That’s a lot of drugs – where do they all end up, anyway? They make ‘em, we take ‘em, our bodies excrete what we don’t use and waste water treatment plants try to filter them all out. But all those pharmaceuticals, from antibiotics and anti-convulsants to mood stabilizers and sex hormones, are showing up in our drinking water. Certainly the concentrations of these drugs are tiny – far below the levels of a medical dose, but studies have found alarming effects on human cells and wildlife. Now I like two-headed frogs as much as the next person but your Levitra, Digoxin and Xanax in my iced tea? Gee, maybe I’m not thirsty after all!

There are enough strange facts and weird stories about pharmaceutical drugs to make you swear off them forever. Take Viagra. It’s popular, very popular. But did you know that Hitler took a primitive type of the drug? He got injections of testosterone and a cocktail made from the semen and prostate glands of young bulls to give him enough mojo for Eva Braun. Ewww…. Then there’s Metformin, a diabetes drug. It smells like dead fish so people don’t take it for long. Hmm – wonder what the fish in the water supply think of it when it floats by…. You know that polar bear charity you’ve been thinking of donating to? Stop procrastinating. Polar bear poop may be the secret to killing the MRSA superbug. (I wonder if the sewer-scraping guy and the polar bear poop-collecting guy are one in the same.) Here’s a weird drug – Improvac. It’s used in 53 countries to chemically castrate pigs going to market. Brits would rather not eat pork shot through with the stuff but it does rid the meat of that nasty “boar taint” caused by the release of hormones. “Boar taint”. Yikes. Maybe I should have had the fish last night. Hey – you’ve heard of Ambien, right? It’s a sedative for folks that have trouble sleeping. It’s also a hypnotic (LOVE that term – picture a guy clucking like a chicken as the entertainment at your next party). Though intended to treat insomnia, Ambien can cause an unbalance of chemicals in the brain and CAUSE insomnia! Isn’t that fun? But get this – one night in January of 2003 a woman took some Ambien and fell asleep. Then she wandered out into the freezing Denver air in her nightshirt. She got into her car, caused an accident, urinated in an intersection and got into a free-for-all with a policeman. But wait! Another woman popped an Ambien and fell asleep. Then she got up and went into the den where she stared in horror at the Christmas tree for half an hour because it was growing through the roof and letting the snow in. When her husband came into the room she took one look at his melting face and collapsed – wow! What a party drug! As a matter of fact, didn’t some mistress of Tiger Woods say they liked down a pill or two and have “crazy Ambien sex”? OK, OK – no need to push, people. There’s plenty for everyone!

Speaking of drugs that make you want to gamble compulsively, a trip to Las Vegas might be a welcome break from all this prescription drug insanity. But leave those smoking-cessation drugs behind. No non-smoking casinos for you! “Some patients have reported changes in behavior, agitation, depressed mood, suicidal thoughts or actions when attempting to quit smoking while taking CHANTIX“, so relax! Light up! You’re in
Sin City to have some fun. You don’t want to end up all, “My last cigarette! Thanks, Chantix!” with a .45 to your head, right? Oh. That is, of course, unless you really do bet the mortgage on #22 black.