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.

1-800-875-9022 Phone

1-800-875-9022 Direct Fax

mailto:tdenton@ApexMedicalPlacements.com

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.

 

 

 

The Legend of Stingy Jack and the Halloween Lantern

I realize I should be living up to the promise I made last week to write about medicinal marijuana, but it’s Halloween! After carving pumpkins, making spider cupcakes and eating Tootsie Rolls I find it impossible to be serious. And speaking of pumpkins, it’s rather odd that once a year we carve scary faces in them, light them up and put them on our front porches. Whose goofy idea was this, anyway?

Actually, the jack-o’-lantern has been around for centuries. I should have figured out from the “o” in o’-lantern that the custom originated in Ireland. You see, there once was a man, a miserable old drunk by the name of Stingy Jack, who loved to play tricks on his neighbors. No one was safe from his pranks – not his neighbors, his friends, nor his dear old mother. He was such a jokester, the story goes, that he bragged he could fool anyone – even the Devil himself. One day Jack went down to the corner pub for a pint when he spied the Devil at a table with a tall glass of bitter ale in front of him. Stingy Jack looked at the glass and licked his lips. “I’ll have me pint,” he thought to himself, “but I won’t leave this establishment a single shilling lighter.” Taking a seat at the Devil’s table he said, “You’re a man of some reputation! Certainly your money is too good for a working man’s tavern. What if I told you I have a way we could drink the evening away and pay nary a pence?” The Devil motioned Jack to continue. “Turn yourself into coin,” Jack said with a smile, “and I’ll pay for our drink. Once the barman has been paid, turn yourself back again!” The Devil agreed and turned himself into a gold piece. Jack took the coin but instead of buying more ale he put the gold next to a silver cross he carried in his pocket. Now it was impossible for the Devil to exercise his own free will. “Give me what I ask,” Jack whispered to the coin, “and I’ll set you free.” Then Jack told the Devil he had to promise that he would not bother him for a year and that if he were to die in that time he would not take his soul. Reluctantly, the Devil agreed. Jack removed the coin from his pocket and put it down on the table, whereupon the Devil returned to his former self. “Good day to you now,” Jack said with a sly smile. “And remember our bargain.” Whistling a tune, he tipped his hat to the Devil and left the pub, proud that he, Stingy Jack, had put one over on Lucifer himself. The Devil, content with the knowledge that time was on his side, sat down and ordered another drink.

It was a lovely summer day when Jack was wandering through the countryside and came upon the Devil sitting under an apple tree. “Now’s my chance,” Jack thought, “to buy myself a bit more time.” Jack doffed his hat to the Devil and bowed low. “I’ve had a few months to think,” said Jack. “I took advantage of you that day in the pub and I’d like to make amends. We could have a meal together. I have bread, cheese and a few turnips in me rucksack – even a jug of wine! The gorgeous apples in this tree would make our lunch a beautiful thing. Ah, but this bad leg of mine! I’ll never be able to reach that delicious fruit. Would you be so kind as to climb the tree and pick us an apple or two?” The Devil thought for a moment and decided that climbing the tree would only be to his advantage, since it would put him above Jack. He began to climb. Then Jack reached into his rucksack for his knife and quickly carved a cross into the bark of the tree. “I’m too clever for you!” cried Jack. “Now you’ll agree to leave me in peace for the rest of my days. And when my time is over, you’ll not make my soul your own.” The Devil, faced with the prospect of sitting on a branch for the next ten or twenty years, reluctantly agreed. Jack chipped the cross away with his knife and the Devil came down from the tree.

A few years later, Jack died and met St. Peter at the gates of Heaven. “You’ve lived the life of a blaggard and a drunkard,” boomed St. Peter. “You’ll not be entering here. Your fate lies that way.” Peter pointed to a path that wound down a mountainside into the darkness below. Jack started down the path and after walking for days through inhospitable and treacherous country, he came once more upon the Evil One. “Jack, my boy!” said the Devil. “I can’t say I’m surprised to see you here. You look like you could use a bit of hospitality but I made you a promise and a promise I shall keep so I’ll stick to my word and not take your soul. You won’t be entering here, either. Off with you now!” Jack turned to go. “Please, Devil,” said Jack. “I know my fate is my own. But there’s nothing but the darkness out there. How will I know where to go?” Lucifer laughed the laugh of the triumphant and tossed Jack an ember from the flames of Hell. Jack sighed, sat down and pulled a turnip and his knife from his rucksack. “I’ve no idea where I’m going,” said Jack, “but I’ll surely be able to see my way there.” He hollowed out the turnip, placed the glowing ember inside it and started on his way. And the poor beggar wanders still, lighting the path ahead with his Jack-o’-Lantern.

(The Irish in America, of course, found the native pumpkin much easier to carve and so the custom was born!)

Happy Halloween to all of you from all of us here at Apex Medical Placements!

 

 

 

Up in Smoke II: The Banning of Cannabis – 30’s Style

“Was it marijuana, the new Mexican drug, that nerved the murderous arm of Clara Phillips when she hammered out her victim’s life in Los Angeles? . . . THREE-FOURTHS OF THE CRIMES of violence in this country today are committed by DOPE SLAVES – that is a matter of cold record.”

                                                                Annie Laurie, columnist – Hearst Newspapers

William Randolph Hearst was the best known newspaper publisher of his day and the originator of yellow journalism. His “sensationalized stories of dubious veracity”, as Wikipedia puts it, shocked and inflamed his readers and whipped up popular support for his favorite causes, the criminalization of cannabis being one. Making the weed illegal was a goal that spoke not only to Hearst’s political and racial biases – it would also make him wealthier, and he wasted no time putting his considerable journalistic weight behind it.

In the early 20th century agriculture and industry in America had a show-down. Rudolph Diesel’s brainchild, an engine patented in 1898, ran on peanut oil. When he took the engine to the 1900 Paris World’s Fair a scarcity of peanut oil made him turn to hemp oil to power it. Both the fuel and the engine were a success and Diesel’s name was made. At the time hemp was one of the largest agricultural crops in the world. Strong, soft and durable, its fibers stood up to salt water better than cotton when made into rope and sails. In addition to fuel, pressed oil from hemp seeds was used in paints and varnishes and hemp could be used to make better paper than wood for less money and without the polluting chemicals used for processing wood pulp. By 1938 the magazine Popular Mechanics called hemp the “Billion Dollar Crop”. G.W. Schlichten’s “decordicating machine” (hemp’s equivalent of the cotton gin) allowed cellulose to be processed from the “hurds”, or material left over once the fibers were removed. The cellulose was then used to manufacture literally thousands of products, from cellophane to explosives.

Motivated by a desire to find uses for agricultural surpluses, Henry Ford experimented with different crops to make a resin that could be used in the manufacture of automobiles. His “special interest”, according to hempplastic.com, was converting soy meal into plastics. When the first resin car was unveiled, the only steel used was for its tubular frame. Ford eventually abandoned soy for a resin recipe of cellulose fibers of wheat, hemp and sisal. Then he added binders and molded it all under hydraulic pressure to create body panels, steering wheels, gearshift knobs, dashboards, trim – even windows. This was Ford’s vision of an automobile “grown from the soil”. It weighed a ton less than a comparable steel car and impact tests showed it to be ten times stronger, as well. By 1941 Popular Mechanics featured Ford in the hemp fields on his large estate and his “plastic car” was introduced with great fanfare. There is no doubt that manufacturing and powering cars with plant sources would have been a great boon for the agricultural industry. “The fuel of the future is going to come from fruit like that sumach out by the road, or from apples, weeds, sawdust — almost anything,” Ford said. “There is fuel in every bit of vegetable matter that can be fermented. There’s enough alcohol in one year’s yield of an acre of potatoes to drive the machinery necessary to cultivate the fields for a hundred years.” But by late 1941, Henry Ford, the master of publicity, no longer advertised his car. Petroleum-based products were about to steal the show.

In the 1920’s the DuPont Company, originally an explosives manufacturer, began to branch out. After World War I ended the company found greater profit in the manufacture of artificial fibers and began making cellophane. Next DuPont acquired General Motors and joined with Standard Oil (now Exxon) to produce the lead additive in gasoline known as ethyl. In 1935 the company made its most important discovery – Nylon, with many synthetic products, such as Lucite and Teflon, to follow. Andrew Mellon, banker and business magnate, was DuPont’s largest investor. In 1921 Mellon resigned as president of the Mellon National Bank to become the U.S. Secretary of the Treasury, a post he held under three presidents until 1932. He appointed Harry J. Anslinger (who would later marry his niece) to head the Federal Bureau of Narcotics and Dangerous Drugs. Anslinger was an ambitious sort and he knew the Bureau was a great career opportunity. The problem was that the depression was threatening to defund his organization. He needed to find a new threat to justify the Bureau and his role within it – opiates and cocaine weren’t enough, so he latched on to cannabis and began his work to make it illegal.

Anslinger’s style was well-suited to Hearst’s. Anslinger got busy stirring up racial fears to turn cannabis into a national threat. He ordered his field agents to compile the most horrendous and depraved crimes in the nation into “The Gore File” which he then promoted and read from frequently: “There are 100,000 total marijuana smokers in the US, and most are Negroes, Hispanics, Filipinos, and entertainers. Their Satanic music, jazz, and swing, result from marijuana use. This marijuana causes white women to seek sexual relations with Negroes, entertainers, and any others.” Likewise, Hearst hated minorities and he used his newspapers to stir up racial tensions at every opportunity. Hearst papers portrayed Mexicans as lazy, degenerate, violent, job-stealing marijuana smokers. Hearst’s father, U.S. Senator George Hearst, had acquired hundreds of thousands of acres of land in Mexico for 20 cents apiece following the surrender of Geronimo. The loss of 800,000 acres of that prime timberland to Pancho Villa during the Mexican Revolution may have had something to do with the younger Hearst’s point of view.

While DuPont developed and patented fuel additives, synthetics and plastics, other companies were developing products from renewable plant sources. The hemp decorticator promised to help hemp dominate the paper market, eliminating the need for wood pulp paper. The Hearst news business and wood pulp paper were a marriage made in heaven. Hearst still owned vast amounts of timber and hemp was a threat to its value. For every product made from petroleum sources, Henry Ford and other companies promised better and cheaper alternatives made from cannabis hemp. Something had to be done. Meeting in secret, Hearst and the DuPont’s decided that hemp was too much of a threat to their billion dollar dynasties. Cannabis had to go. The tycoons, assisted by an eager Anslinger, took the little known Spanish slang term “marihuana” and pushed it into the public’s awareness. For two years, from 1935-1937, DuPont lobbied Herman Oliphant, chief counsel of the Treasury Department, for the prohibition of cannabis. Petroleum-based synthetics, DuPont assured him, could take the place of hemp in the marketplace.

It’s surely no coincidence that the Marihuana Tax Act made the possession or transfer of cannabis illegal throughout the U.S. in 1937. Cannabis used for medical and industrial uses had an expensive excise tax applied to it, making it more expensive for manufacturing than petroleum sources. In fact, other bills introduced to Congress proposing a national energy program based on the country’s vast agricultural resources were killed by the petroleum industry. Gasoline was clearly inferior to Cannabis hemp fuel. It had a lower octane rating, was more toxic, dangerous and polluting. No matter. Sensationalist smear campaigns paid for by petro-dollars slashed the hemp industry down to the ground and gasoline emerged as the twentieth century’s dominant fuel.

If you were born in the 50’s or before, you may have been shown the 1936 film “Reefer Madness” in school. We all love to look back at the stern, straight-faced 1930’s anti-marijuana propaganda and laugh at the level of ignorance that was once taken as Gospel. Yet there is virtually no history of concern about the evils of marijuana use in America until the passage of the Volstead Act in 1919, which prohibited the use of alcohol. Hysteria over cannabis use was easy to cultivate because of the divisions and corruption caused by prohibition. Hearst and the DuPont’s, in conjunction with corrupt or misguided officials like Anslinger, popularized dozens of movies, books, pamphlets and newspaper articles condemning cannabis. By 1930 many states had not only criminalized it but had labeled it as a narcotic. The FBI’s annual Uniform Crime Report estimated that some 723,627 people were arrested for cannabis violations in 2001 – nearly half the drug arrests in the country. Of those, 88.6% were charged with possession only, including those whose cannabis was grown for medical use. Since 1992, approximately six million Americans have been arrested on cannabis charges, illustrating the fact that the lunacy of the Reefer Madness days is not gone, but haunts us still. Little wonder, then, that the research and development of cannabis for medicinal use is just a distant dream.

Next week: searching for the truth about cannabis as medicine

 

Up in Smoke: California’s War on Medicinal Marijuana

In a complete about-face of Obama’s promise not to target medical marijuana users in states that allow it, the Feds are threatening to shut down pot dispensaries throughout California. Earlier this month Federal prosecutors began sending out letters to dispensary landlords threatening to bring charges and seize property unless they close down the businesses within 45 days. In an interview with the LA Times, Joe Elford, chief counsel for Americans for Safe Access (an advocate group for medical marijuana) said the move is “coming out of left field as far as we’re concerned.” The article goes on to say that only certain dispensaries have received letters and that the Feds have refused to comment on the criteria used to target them. I guess you could say this is the part where Obama takes resources away from serious crime-fighting and puts them into snatching doobies out of the hands of cancer patients. Whoa. Heavy, man.

Cheap drug humor aside, the medical marijuana issue is as confused as a narc after eating a plate of Alice B. Toklas brownies. Sorry. But seriously, marijuana’s history in America is crucial to understanding the resistance to its use as a medicine today. Many assume that it is a nothing more than a dangerous “gateway” drug, made illegal after years of Congressional hearings based on testimony from scientific and medical experts. But that would be over-simplifying things a bit. Actually, marijuana use goes back some 7,000 years and was legal in this country as recently as when Ronald Reagan wore short pants. That means it has been illegal for only 1% of the time man has been gathering or growing it. Makes you wonder, doesn’t it? I mean, what do we think we know now that 70 centuries of marijuana use didn’t teach us? Or is the move behind criminalizing it, like so many other things in this culture, based on politics, race and economics?

It would probably blow your mind (OK – I’ll stop) to know that the first law in the U.S. regarding cannabis actually supported it (and from here on I’ll refrain from calling the weed “marijuana” because of its negative associations with recreational use). In 1619 the Jamestown Colony in Virginia began requiring farmers to grow hemp, the non-intoxicating relative of the plant everybody is getting so excited about. Hemp is an amazingly useful plant that was eaten, made into paper, cloth, rope and sails. The military found it so valuable that someone could be jailed for not growing it in times of shortage. In those days hemp was even used as legal tender and was accepted as payment for taxes. According to Jack Herer’s classic book, The Emperor Wears No Clothes”, even in 18th century England “the much-sought-after prize of full British citizenship was bestowed by a decree of the crown on foreigners who would grow cannabis, and fines were often levied against those who refused.” Its popularity did not wane; in 1850 the U.S. Census counted 8,327 hemp farms.

You know, it never ceases to amaze – aside from its indigenous people, America is a country of immigrants, yet one group of them or another is always in disfavor. The Chinese, Germans, Irish, Southern and Eastern Europeans, Catholics and Jews (no matter where they were from), Middle Easterners – all have fought bigotry and discriminatory legislation to settle here. The history of the use, abuse and criminalization of cannabis and other substances is all tangled up with our attitudes toward these newcomers. Anti-Chinese sentiment led to the very first anti-narcotics law in the country – an 1875 ordinance in San Francisco against opium dens. It was the California Board of Pharmacy that created many modern techniques of drug enforcement, like undercover agents, informants, criminalization of users, anti-paraphernalia laws and drug raids. Henry J. Finger, a prominent member of the Board, was a rabid drug prohibitionist who, in addition to the scourge of Chinese opium, pushed to have cannabis included in federal drug legislation. This time he blamed East Indian immigrants that had arrived in San Francisco in 1910: “Within the last year we in California have been getting a large influx of Hindoos and they have in turn started quite a demand for cannabis indica; they are a very undesirable lot and the habit is growing in California very fast…the fear is that now they are initiating our whites into this habit…”. The “Hindoos”, according to Dale Gieringer’s The Forgotten Origins of Cannabis Prohibition in California, “sparked an uproar of protest from Asian exclusionists, who pronounced them to be even more unfit for American civilization than the Chinese.” They were “widely denounced for their outlandish customs, dirty clothes, strange food, suspect morals, and especially their propensity to work for low wages.” Apparently, Finger was the only one to complain of their cannabis use. Others saw them as hard-working and sober.

But of all the hysteria wrought by other nationalities upon our shores, perhaps none have moved us to plain, old-fashioned irrationality like the Mexicans. In the early 1900’s western states were anxious because of the numbers of Mexicans coming over the borders. In 1916 the Mexican Revolution spilled into the U.S. when Pancho Villa raided Columbus, New Mexico and Uncle Sam chased him back. Some years later tensions developed between small farmers and the large farms that used cheap Mexican labor. Much was made of the fact that the Mexicans smoked cannabis and had brought the plant with them. “Marihuana” was soon noticed by the pharmacy journals and was written up as a relative of Indian hemp or possibly jimsonweed. Because it was associated with criminals in Mexico, it became linked to violence and insanity. The Mexican connection pushed the California Board of Pharmacy over the edge. They felt duty-bound to legislate against “loco-weed” in 1913.

The racial divisions that have plagued our society since its inception have led us to discount or dismiss much of what immigrants have brought with them. The United States is one of the only industrialized nations on the planet that does not grow hemp. Instead, we import $96,000,000 worth of hemp products each year. The medicinal properties of Cannabis have a long track record – the earliest written reference goes back to China in the fifteenth century B.C. If America would only take the blinders off it would see that the implications of the legalization of cannabis for both industry and medicine are huge. In 1975, the National Institute on Drug Abuse issued its Fifth Annual Report to Congress on Marijuana and Health in which it recognized cannabis as an ancient healing drug: “One should not summarily dismiss,” the report went on to say, “the possibility of therapeutic usefulness simply because the plant is the subject of current sociopolitical controversy.”

Next week: the economics of the criminalization of cannabis.

 

 

Is a New Golden Age on the Horizon for Pharmacy?

I once heard a pharmacist remark that they are in a losing battle because the nature of business conflicts with the nature of the profession of pharmacy. The nature of business is making profits. In retail pharmacy profits are made by filling as many prescriptions as possible with as little help as possible. But the nature of the profession is health care. Health care practitioners promote health and well-being. Pharmacists make clinical decisions and judgment about medication therapy – which drugs are appropriate for an individual and which are not, how to take medication properly and how to recognize the side effects. In fact, the principal goal of pharmaceutical care is to achieve positive outcomes from the use of medication which improves patients’ quality of life. Ah, there’s the rub: the provision of conscientious clinical care and the business of retail pharmacy, in its current incarnation anyway, do not mix.

The complaints of retail pharmacists are fairly universal. After spending six years and thousands of dollars earning a doctorate in pharmacy, pharmacists use their extensive knowledge of pharmacology and their clinical training to stand on their feet twelve hours a day arguing with insurance companies on the phone. Oh, and directing customers to the cereal aisle. In between phone calls and customer interruptions they find the time to input, fill and check prescriptions, make sure techs aren’t making medication errors, giving patients the wrong information or escalating a situation with an irritated customer. Meanwhile, the market forces are closing in on them. Endless mergers mean that pharmacy chains are consolidating power within a short list of companies who decide how business is conducted. Mergers amongst pharmacy benefit managers and insurance companies give them an ever-growing influence over the direction of the profession. Pharmacists are nervous over the move towards automation, the increasing role of technicians, the mushrooming of pharmacy programs and the influx of foreign pharmacy grads flooding the market with hungry newcomers willing to work longer and harder for less. All in all, the picture for retail pharmacists is not a pretty one.

Some say the golden age of pharmacy is over. The squeeze is on for pharmacists to crank out the prescriptions, sacrifice quality to quantity, bend over for management and insurance companies and de-emphasize their skills as drug counselors and educators. But as blogger Pharmacy Mike wrote, “Maybe big box stores are not the best future for all of us highly educated drug experts.” Maybe not, indeed. Costco, Walgreen’s Wal-Mart and CVS will continue to push pharmacists out of the equation because increased use of automation and mail-order mean less labor and less labor equals higher profits. The hope for pharmacists is not to rail against the pressures of the retail business model but to expand their considerable skills and knowledge into a completely new direction.

Last week I wrote about the turf war that’s heating up between physicians and non-physician providers like nurse practitioners, physician assistants, dentists and chiropractors. Due to the state of our healthcare system there are millions of neglected or underserved people in need of care. The time is ripe for the development of new methods of healthcare delivery. We don’t lack competent providers who can step up and meet the need. We lack leaders who can face up to the arrogant posturing of medicine. Pharmacy must take its proper place within the medical community and demand the right to diagnose and prescribe. By deferring to the American Medical Association, pharmacy has given up its only true professional responsibility related to pharmacotherapy. Pharmacists can’t be first-rate drug therapists until they practice drug therapy. And the job of dispensing drugs in a retail drug store has almost nothing to do with pharmacotherapy.

There’s a lot written in the pharmacy blogs about the dreadful situation retail pharmacists find themselves in and many say they are “stuck on the sidelines” with neither the will or the power to do anything about it. But the winds are beginning to blow in a different direction. The Pharmacy Manpower Project’s 2009 National Pharmacist Workforce Survey indicates shifts in the pharmacy profession toward more patient care. Despite the economic situation, the study results show that pharmacists are in high demand and that the profession has the “capacity for contributing to the reforming healthcare system to meet patient care needs”. The survey surely reflects the fact that as the Affordable Care Act is phased in, some 33 million people will have expanded access to insurance coverage. That, along with an aging population and increased incidence of chronic illness, which is almost always treated with medication, suggests we’re going to continue to need pharmacists. Maybe those increasing numbers of pharmacy graduates will have something to do, after all.

Speaking of pharmacy schools, the need for pharmacists to increase their clinical opportunities and influence is not wasted on administrators. Some pharmacy schools have blended a PA program with the PharmD program, the perfect stepping-stone to pharmacists being able to prescribe in their own right. This is the only sensible future for pharmacy and educators know it.

As the market forces the profession on to a new tack, pharmacists may breathe a little easier. All is not lost. But as the current business model dies, countless pharmacists will be affected. States have individual pharmacy associations and the national organization, the American Pharmacists Association (APhA), is the largest association of pharmacists in the United States; the structures exist for pharmacists to come together and influence legislatures, both state and federal, to make changes. But out of about 269,000 pharmacists in the country, only 60,000 belong to the APhA. Pharmacists often say they are the introverted type – not joiners, and they’re notorious for not organizing. But consider the Tea Party. No matter how you feel about them or their backers, Tea Party activists literally commandeered the machinery of the Republican Party on the local level in order to elect their representatives and enact their agenda. Their influence on the system, for better or for worse, is obvious. Real change comes from the bottom and it would serve pharmacists to take over their associations in numbers. Many may not be convinced of the need to get active or of its potential but the time is coming when more will find themselves compelled to go to a meeting, write an email or make a phone call. Change is in the air but things will likely get worse for the profession before it gets better. And nothing motivates a person to action like an empty pocketbook.