Remember, the camera adds 10 pounds....

First off, Stuart Speedie is Dean Speedie's husband, and is a researcher in health information technology. He's also quoted in this article on telemedicine. This is going to be a short post-but I just want to make one connection that you likely have made already-how could this affect pharmacy? A lot of pharmacist are consultants to nursing homes and review their charts once a month. Well, what if they could do it remotely and talk to patients through these means? Same with MTM-do people have to be in the same room in order to deliver pharmaceutical care? I guess we'll see where this change in compensation leads....

Ethical stuff

First, for dramatic interlude, listen to this song in the background while reading the next two posts. Just open it up in another window and enjoy. That's right, even though no one is looking at this, I'm demanding my own background music. I guess my ego knows no bounds....

Awhile back I threw out that the WSJ, and specifically the WSJ blog, were must reads for health news. Current and up-to-date reporting, good insight, you know, that stuff. And, of course Pharmalot is great for pharma related news too. Well, the New York Times is making a run at them. Last week they had a great piece on research being done on real patients, with real problems. Ever look at a journal article and check out the exclusion criteria? I'm pretty sure I'd be excluded for stepping on a nail as a kid. You would be excluded (yes, you!) for reading this blog (read this) But when used in real life patients, you can't exactly exclude everyone from using your drug. You'll miss out on market share. But then, how would a drug become approved-so many complications/adverse events would show up in the study it'd be laughed at. Now you see why I labeled this "Ethical Stuff."

Well, the New York Times wowed me yesterday with this article looking at the cost of a life. In the time of serious calls for health care reform and complaints of rising health care costs, you have to ask: At what point does it stop? At what point do payors, and possibly, if we go to a single-payor system, does the government, say that it is too much for a drug. For a great analysis, check out the Pharmalot blog, and read the comments, particularly from "Michael" on December 3rd at 9:39am. Obviously, he's an insider for Pharma, but still, it's a strong point.

Things to consider as we get ready for change. Also, be sure to respond to the APhA Call to Action to actually participate in health care reform. If pharmacists aren't at the table, pharmacists won't have a say. It's that simple.

'CCO giving pharmacy some love

Here's the link to the WCCO discussion about decreasing med costs. They mention the $4 generics and prescription assistance plans, but they also throw a shout out to MTM. If only threw out the phrase "The most expensive drug is the one taken incorrectly" they might have helped us out. Oh, and here's the link to the blog discussed as well. Hopefully patients are willing to pay for the money saved....

Why are Obama's cabinets so important?

I mean, really. When my parent's got new cabinets, no one cares. When I do, again: No media attention. But all of a sudden, you're elected Pres-elect, and everyone cares about your kitchen...wait, what? Oh...boy, is my face red.

So, this is kind of huge. Well, maybe not huge, but it's going to have an effect on pharmacy. How? Well, I don't know. Sorry. But, Daschle's reportedly been angling for this for awhile. He supported the failed Hilary Health Care plan from the 90's (first years may not remember that, so here's some info on it) and is up for health care changes. Include the fact that meds take a huge chunk of overall health care (according to this vid) and you can expect some changes to occur in...oh...say...the next four to eight years.

Why tell the real news when the fake news is so much funnier

I go to Comedy Central for news television, and I'm ok with that. I mean-who wouldn't?




Now, that's just plain good stuff. Plus, he hit the news right on the head. Let's run through the highlights.



I'll try and run through the topics he discusses in later posts, but I'll let you enjoy the video for right now.

Cuz I want you back for good...

So, no one read this before, and likely no one will read this now. But you know what, I had a lot of fun writing it last year. So guess what, the blog is back! (Dramatic interlude for cheers and adulation. Shout out to Barack for showing me how to be humbly be showered with praise.)

Why is the blog back? Because there is just too much happening out in the world of pharmacy and health care to not at least make some kind of commentary on it. Sure, you could go to news sites and read the actual journals, but what fun would that be? Here you get few if any pictures, poor wit and sarcasm, and really no value added to the links I post. But hey, if you visit, it makes me feel good. Enjoy the updates.

Pharmacist's in Primary Care?

The decrease in the number of physicians that pursue primary care has been noted over the past few years. The impact of this has contributed to increasing health care costs, and and a decrease in patients seeking primary and preventative care. This dearth of primary care physicians essentially created the market for nursing practitioners and physician assistants. However, this has still not solved the problem.

So, could pharmacists help out? We know that we are trained in disease management-particularly those that are often controlled primarily by medication therapy-diabetes, anti-coagulation, asthma, heart failure....ummm...there's probably more but I read too good. Well, the good folks at JAMA thought they would take a look at what pharmacists can do in the CHF. They have a spin-off mag called the Archives of Internal Medicine. It's pretty good, no People magazine or anything, but I like it.

Anyways, here's the article that they printed in Internal Medicine. I heard about it, where else, but on the Wall Street Journal Blog. Check out the links in the article too-they talk about the decrease in utilization of primary care and increase in specialty reimbursement mentioned above. They also discuss the 10 City Challenge sponsored by the APhA Foundation.

Short rant here: Stupid WSJ also is now making you pay for their Health page. At the least, they still give you access to their blog. But come on, Rupert Murdoch (who recently purchased the WSJ from the Hathaways) let me have access to the WSJ!!! I'm looking for some kind of online petition to make it all free, but I haven't found it yet. Let me know if you do, please.

Will drug companies write my papers?

No, really-will they. Cuz that'd be sweet. Now why do I say drug companies instead of, oh, English Majors? Well, according to JAMA it seems that they are more than willing to write them for academia studying their drugs. CNN has the shortened version of this and some discussion on it. One journal official who looked into it said: "The manipulation is just disgusting. I just didn't realize the extent." Merck counters that 5 of the 6 authors were involved in the Vioxx case against Merck. Slight bias. Great article. Less filling.

Students stepping up...and more

First off: Thanks to Kassy Bartelme and Colleen Flaherty for these next articles. Also, they tipped me off to Pharmacy Practice News. There are two things in life that make me happy: Spring and new pharmacy related news websites. I should probably say Laura too, but she doesn't read this anyways, so whatever.

Ok, back to real news. Medication Reconciliation is one of the goals within JCAHO. Goal 8 if you really want to know. If you work in a hospital, you've likely heard of "Med Rec" and 1) know it's important 2) know it's difficult to get accurate and 3) likely know that pharmacy isn't always involved. Last year at APhA2007, APhA-ASP brought this up and wanted to make it a priority for pharmacists and student pharmacist to the be the health care practitioner that provides this care.

Well, it looks like students CAN make a difference. Proof? Here. By the way, you have register with Pharmacy Practice News, but, ummm....we're entering pharmacy practice, so why not learn about the news within pharmacy practice. Plus, it's free.

Ok, lots of comments could be made on this. Let's do a pro/con debate. Against myself. Or for myself. I get confused. I'd go on Zyprexa, but I might get diabetes.

Pro: Students are learning about med rec. They are engaging patients in the role of a pharmacist, and are showing patients that we can do more than dispense. Patient outcomes are improving.

Con: Students shouldn't be used to do work pharmacists should be using. Hospitals should find a better way to do med rec. Interns should also be trained to do this (who are being paid) not students (who are paying)

Comment below-you can do that you know.

My greatest fear...

I always knew this blog was a bad idea....

What happens in Vegas, stays in Vegas

Ok, this has no connection at all to current events, in fact, it's probably from before many of you were born, but I'm going to post it anyways.

For Outcomes, one of our drug info questions dealt with the use of Cialis and nitrates. Through my research into the subject-I ran across this article on ED. Read the first paragraph in Editorial Comment 1. My only thought is, I guess urologists must be pretty used to displays like this.

Also, here's an article on Cookie Monster. Hey, I'm just trying to liven this place up. IS ANYONE OUT THERE!!!???

Pick your vices wisely

So...in college, we called this idea the buffalo effect, and it pretty much follows evolution: The weak brain cells die, and the strong survived. Yeah, turns out we were wrong back then, according to this article.

But, there is hope for using daily diuretics. Though alcohol is bad, caffeine might be good. According to this article, caffeine was neuroprotective. Well, in rabbits, no testing in humans yet. But whatever-I likes me my macchiatto.

Ziagen and Videx raise heart risk

A study in the Lancet found that the use of Ziagen (abacavir) and Videx (didanosine) raised heart risk. During the anti-viral section in Pharmacotherapy IV, some discusiong alluded to this: As people with HIV and AIDS live longer, the complications associated with long-term drug therapy will be a more significant risk than their actual AIDS. I'm obviously not an AIDS expert (no comment on my grade for the module...) but I think there will be a lot more information coming out on the issues of long-term AIDS therapy.

Just as a reminder, or to let you know for the first time, abacavir was developed right here at the University of Minnesota by Dr. Robert Vince. That's pretty cool.

Residency Talk

For those that attended APhA2008 or have heard other talk of this, one of the hottest topics within pharmacy is the expectation that by 2020, all pharmacists who wish to enter into patient care will have completed a one-year residency. This is a controversial topic for many reasons, not the least of which is whether or not there are enough residencies (commentary on that topic here) There are numerous articles discussing this-and I suggest you keep your eyes open for further discussion on it. For background, try googling "JCPP Future Vision of Pharmacy." I think this will lead you to many easily accessible discussion of what the future will hopefully be. Here's a copy of the original statement as well.

What reminded me of all of this was an article discussing nurses pushing for a doctorate in nursing to act as primary-care practitioners. I won't delve too much into this article-but one line caught my attention: By 2015, the American Association of Colleges of Nursing aims to make the doctoral degree the standard for all new advanced practice nurses, including nurse practitioners. Seeing all of the discussion that pharmacy is having, I felt this was a bold statement and prediction for them to make. Think of the impact that this would have on nursing education, and how closely this likely mimics the discussions that pharmacy is having right now.

I won't belabor this too much more, and I don't know how I feel on either way of advocating for residencies or not. But when we discuss, as a profession, what we want our future to look like, I think we need to remember that we need to find the best way for us to be the best medication experts for patients available and decide how we are going to get there, or other professions will decide for us.

Minnesota = Kind of a big deal

For those that went to APhA2008, you received the most recent copy of JAPhA, you may have seen this. You remember MTM? Well, apparently, it saves patients a lot of money on their medical expenses. Now, I'm no genius, but I did stay at a Holiday Inn Express last night. So I think that people may pay attention to the cost savings that can occur with MTM, and will help for it to be reimbursed. Good work to the good folks at Fairview Hospitals and Clinics and the good ol' University of Minnesota College of Pharmacy. I also think it may fall in line with the goals of Project Destiny, a collaboration between APhA, NACDS and NCPA.

Also, just a reminder of other cost savings programs, here's some info on the Asheville Project, which most of you have likely heard of by now.

TB Talk

I may or may not listen to NPR constantly. I won't comment on either side. But, one time, I happened upon a story that I found very interesting: On tuberculosis in Bangladesh. Two important things to note before going to the NPR piece: 1) Drug resistance to TB is a problem worldwide. The WHO checked this out recently, and I mentioned it a few weeks ago.
2) Bangladesh is a poor country and one of the most population-dense countries in the world. Bangladesh also just suffered a horrible hurricane last November.

So, judging by those two facts, one might say Bangladesh would have a horrible rate of MDR-TB. Meh, turns out-no. How'd they do it? Well, take 5 min, and listen to the NPR piece.

Some interesting points, and I'll just throw out two words: Alligned incentives. It's amazing what can be accomplished if an entire population believes in one goal.

Heparin Follow-up

Seriously-how many times will heparin come up in the news? Just seems strange to me. The recall of Baxter's heparin supply (oh, and Baxter supplies about half the heparin to the US) caused some ruffles, especially if you work on a hospital. Or, if you work in Germany. Also, they figured out what was in the heparin that caused nearly a thousand allergic reactions, and several deaths. Here's an article that has links to previous articles if you want more information about the recall.

So, now for the rest of the story. As this editorial from the Washington Post points out-there are some major problems in the drug approval and investigation process. According to this editorial-80% of active drugs are made outside of the US, and not all of those plants are inspected.

Now back to the heparin-Here's a little info on where some of the heparin in our supply comes from. Be sure to click on the slideshow to see more pics-as well as pics from a factory that is quite a bit cleaner and more advanced.

Follow up to Emily Jerry and Techs

We first heard the tragic tale of Emily Jerry back in October. A reminder: Due to a mistake with her chemo drug that was not caught by the pharmacist, Emily passed away. The family, after investigating, filed manslaughter charges against the pharmacist. The family are also proponents of a law in Ohio called Emily's Law. The purpose of this bill is to require pharmacy technicians to be trained, tested and certified, which is also what MPhA is promoting. They are also very prominent in a group called FLAAME-Families Launching Action Against Medication Errors.

One of the supporters of FLAAME is Dr. J. Lyle Bootman, who has won the Remington this year.

Anti-depressant's getting you down?

Well, according to this article, they aren't helping you feel better. Well, a bit of an overstatement: They found, through evaluating 50 trials on paroxetine, sertraline, venlafaxine and fluoxetine, that there was not much improvement found in patients who were put on meds versus those that were only put on a placebo pill. For (the few) third-years in Ethics on Thursday, I guess docs may be prescribing placebos even when they don't realize it. Here's the article on the always reliable Pharmalot as well as the article from the University of Hull where the study was conducted. Also, the UK (where this study originated) has decided to pour more money into training therapists to help out those that are depressed.

It should be noted that there was a difference noted in severely depressed patients, and that anti-depressants did work in quite a bit of the population, just not in an appreciable amount more than in placebo-so if it works for you or your patients-keep 'em on the meds! Thanks to Sarah Mallak for making me aware of this one.

Also, this should not stop you from prescribing meds for your pets (there's even Reconcile-literally Prozac for your dog) Also, the FDA just approved Pristiq or desvenlafaxine for use as well-the advantage over Effexor-XR is there is no ramp up period when initiating therapy. Not to ruin there marketing campaign too much, but I'll quote Conway and say "Scam." Hopefully I don't get hit with a slander lawsuit for that one.

E-prescribing

Thanks to Adele Reichel and Rachel Root, "Guest Bloggers" for submitting some info on e-prescribing:

E-prescribing is definitely something we will all hear more about. Here are some questions for thought:
• How will this impact your practice?
• What would you say to a physician in order to convince her/him of the important role e-prescribing can play in healthcare?
• Do you think this method would work for controlled substances?
• What will you do with the time you were formerly using to process prescription claims?
• The Fox News article states, “Doctors received an annual bonus for prescribing more generics.”Are pharmacists rewarded for dispensing generics, why/why not?

For further consideration, here's the letter from APhA to President Bush. Also, for further information on some examples of e-prescribing companies, check out RxHub and SureScript (p.s. checkout the RxHub ePrescribing 101 Overview as well.)