By the time you read this, the Vaccine = Autism published by the BJM will be old news (Yes, I do write a bunch of rants at once and have them post at a later date).  However lets take a closer look at this whole situation.

Lets keep in mind that I don’t belittle Autism or think its “not important”.  I’m hoping to not only find out what the cause is, but how to prevent it.  Autism, like Down Syndrome, happens and we aren’t sure exactly why or how.   Take a look at how many drugs are out there (that kill people no less) that the mechanism of action is “Undetermined”.  Are you throwing a shit-fest over those? No.  Is some random dipshit actor standing on his/her soapbox about that? Nope.

First off, Jenny McCarthy.  The woman who is best known for her blond hair and big fake tits speaks the gospel about how vaccines contribute to autism. The whole fact that people LISTEN and BELIEVE her shit makes me want to blow the brains out of 99% of society.  She should stick to what she does best, being being eye-candy.  We don’t need “actors” to be the voice of medicine, politics, or anything else that they know jack and shit about.  Lets be realistic, if you listen (and believe) any non-medically trained person’s bullshit about medicine, you are an idiot. Do I ask the random homeless guy on the street how to fix the breaker box in my house?  No. Do people come into my store and ask me how to replace the water-pump in their Escalade?  No. However some random dipshit actor “speaks out” on a topic and people run and proclaim the word like it was given by Oprah herself.  Yes, it sucks that her child is autistic.  It sucks that /any/ child is autistic.  However it sucks MORE that kids need to suffer a preventable diseases because their mom listens to such propaganda given by a non-medically trained person.  I’m sorry Jenny, but I am no longer fapping to pictures of you out of sheer disappointment.  I hope we can still be friends.

Second on the chopping block, the Lancet.  I had somewhat high regard for the Lancet, having used their studies while I was in school.  How in the hell could they let such a bullshit study be published? A study group of 12?  A high school science project has more people in their study group!  But oh-no, its the whole “think of the children” mentality that got this clusterfuck of a study published vs good logical science.  Good going Lancet, now you can “think of the children” as the unwashed idiots don’t immunize their children and they die a preventable death.  I’m planning on releasing a study showing how Vicodin and Soma use cause laziness and stupidity.  My sample size is 20, I hope you publish my study.

Third, and most favorite: Andrew Wakefield.  Dude, when you publish a study with a sample group of 12 on a medication that MILLIONS and MILLIONS of people have received without incident, didn’t you take a step back and think to yourself “Man, maybe something is a bit wrong”.  No, you didn’t.  You published your bullshit to the Lancet, got your 20 seconds of fame, freaked the fuck out of a bunch of ignorant dipshits because you are were a licensed Doctor and thereby had the inherit trust that goes along with the degree.  If you were selling penis pumps (because thats really all you can do now), I wouldn’t even buy one of those from you because your study group would be 12 men who used it!  You did a huge disservice to the profession of medicine.  Your fellow colleagues hate you, nurses and pharmacists hate you, and to be completely blunt you and the Lancet should be brought up on criminal charges for the damage you have done.  You should go have sex with Jenny McCarthy so maybe the common sense recessive trait could be expressed in your children.

Fourth (and finally) the parents who refuse to immunize because of Autism:  I’m a parent – so this hits close to home. To be completely honest its not the job of the government nor any governmental authority to make you vaccinate your child.  Its your child, you can do whatever you want.  However, that being said, if your child develops any preventable disease because you decided to listen to an ACTOR via the INTERNET vs listening to your DOCTOR (I can see how you can confuse the two, they end in -CTOR) YOU should receive zero state aid while the CHILD gets the treatment he/she deserves on our dime (its not the child’s fault their parents are dipshits, so why should they get shafted out of treatment?).  That’s right, no welfare or any public assistance for YOU because YOU decided to not listen to someone who deals medicine for a living.  You can sleep soundly in bed listening to your child squeal with pertussis knowing full well they won’t get the evil Autism because of your good judgment. Right after that, please stick a road-flare up your vagina, because we don’t need more idiots like you breeding.

I will commend BJM to putting an end to this madness, unfortunately its too little too late.  The damage has been done, the lines have been drawn, and you aren’t going to change the opinion of the uneducated idiots.  After all, you are just a “propaganda machine for big Pharma”.  Oh, and calling Jenny McCarthy an actor is a stretch, even in my book.

But wait! Theres more!  For your enjoyment, straight from YouTube, I present my heros Penn (he should have been a Pharmacist!) and Teller’s episode of Bullshit about this very subject:

Part 1:

httpv://www.youtube.com/watch?v=Xo97VouL0ls

Part 2:

httpv://www.youtube.com/watch?v=X_nYMEO82mo

Patient compliance is one of those words that’s thrown around pharmacy school/trade magazines like singles at a titty bar.  Its the illusion that you have the ability to make your patients take their medication like they are supposed to.  Yet another concept that looks great on paper/in the magazines but in real life, not so much (gee, sounds like OBRA90?).

Lets look at this from a realistic standpoint.  You have say 500 patients that you fill medication for on a regular basis.  Do you really believe that you can help improve compliance for each and every one?  You don’t even have time to take a lunch, let alone remind the 90 year old Mrs Smith (who’s clock should of ran out a LONG time ago) that she needs to take her water pill?  Why spin your wheels making MORE work for yourself when you can focus on the patients who ARE compliant, who DO care about their medication, and are willing to work WITH the healthcare system vs just wasting money?  Its just a frustrating losing battle – the sooner you realize this the better off you are.

Sure, you can be one of the pharmacist in the APhA magazines who sit and talk with each patient for 45 min about compliance/MTM/unicorns and pixie dust, but after your store goes under (or you get sued into bankruptcy because your bargain basement techs you hired to do the grunt work killed someone) then will you understand that enforcing compliance is a war long lost? Compliance begins with the patient, plain and simple.  They need to choose their level of involvement of their own health and well-being.

Nothing pisses me off more than having a damn intern pharmacist spend 30 min talking to a patient about compliance.  The patient just gets a glazed over look, says “uh huh” a ton and walks out in no better shape EVERY SINGLE TIME.  Patients don’t want to be lectured about their medication, they want to pick up their government-vicodin and go about their day.  PATIENTS DO NOT CARE WHAT YOU HAVE TO SAY UNLESS THEY ASK YOU FOR HELP.  This is cold sobering fact of retail.  Unsolicited advice gives you blank stares and a “mind your own business”.

So what this boils down to is that once that patient leaves the store with their pills they are on their own to take them correctly.  Stop wasting your time with the hand-holding, they are on their own to take responsibility of their own health (foreign concept I know).  If the patient can’t get their pills straight, well, that’s a whole lot of their problem isn’t it?.  My problem is making sure that the 20 different medications don’t kill them.

You all may think that I’m being quite the asshole about the subject (gee, thats a first!), but the fact remains that I would rather spend my not-making-the-store-money-by-not-filling-Rxs time helping those whom choose to help themselves.  Choose your battles or you’ll have nothing but losing battles.  DrugMonkey and I should teach a class at pharmacy schools.

Not only are non-compliant patients a detriment to themselves, but are a detriment to the entire system as a whole.  Say Mrs Madeupname gets some glyburide.  She just blows off the doctor (and your) warnings about not taking her medication and gets a refill every month (that she just stores/ditches) so “the doctor wont yell at her”.  On her next visit, the doctor will see little/no change in her glucose.  Doctor increases the dose thinking the current medication isn’t working.  Or doctor switches/adds Avandia/Januvia/Actos thinking that will get more control.  See where this is going?  Then when Mrs Madeupname finally feels like shit because her glucose is 500 and takes her meds, she bottoms out her now maxed out dosages and ends up in the ER.  Doctor calls you all pissed off and blames you for not making sure she is compliant (but you are quick to point out by her refill records, she /is/ compliant as far as you can tell).  PLUS the moment you question her about compliance she quickly transfers her medication to WalMart who “doesn’t butt into her own business” (good riddance!).  All this for a $2 dispensing fee.

Now lets talk about the patients who ARE compliant:

There are only 2 settings where compliance actually takes place; controlled substances and patients with high copays/no free ride.

Controlled substances is obvious, when the patient takes them there is an immediate physiological reward.  Your pain/anxiety/etc is gone (or you get a good buzz).  This rewards you to take another dose, and another, and bug your pharmacist for an early refill.  You don’t take your medications and there is an immediate penalty (pain/anxiety/dealing with your shitty life/etc).

Folks with high copays are also more compliant because not only do they have to shell out the cash for the medication, but most (if not all of them) don’t have the luxury of a taxpayer funded ambulance ride/hospital stay if their health goes down the shitter.  These patients are looking at multi-thousand dollar hospital stays/ER visits – they have no safety net of the nanny-government to pick them up when they fall.

They should teach interrogation and water-boarding in pharmacy school.  While they are at it they should teach a mind-reading class too.

Yeah, I know I said 2 posts a month, work has been killing me lately (as it does any pharmacist) so I haven’t had much free time as of late.

Anyway,

Freeitude – The attitude that everything in a pharmacy should be “free” because of the past events of a persons life.  Also called Entitleitude, Pooritude, or Douchebagitude.

One of the most annoying shoot-yourself-in-the-face moments in a pharmacy is when a patient who is on a state/county/city funded drug assistance program/welfare gives you both barrels because they have to “drive across town” to pick up a balance of a $200 medication that they are getting for free.  This act of ungrateful entitlement makes pharmacists and their staff wish for a reduction in population, and mandatory sterilization of the people involved.  It also makes them bitter, and have a general hatred for humanity.  The icing on this cake is that these patients are angry at the world (especially you and your staff) like its YOUR fault that they got hooked on drugs/were born stupid/got hurt and cant work/excuse #424 and put into this situation.  Its annoying, very annoying.

I mean seriously, if someone offered to give me something worth over $200 for $0 (hell, even $5 or $10) would I get pissed off if I had to return the following day to pick up the rest of it? Fuck no! I’m getting $200 bucks worth of goods for nothing!  I’ll gladly return with a smile on my face, a huge thank-you, and an appreciation that cant be measured.

The amount of bitching these patients do about their meditations also lowers my outlook for my fellow man.  Bitching they only received a Lumigan 2.5cc bottle instead of a 5cc bottle (you look up how much Lumigan costs) is like getting upset because the state gave you a black corvette instead of a red one.

Sometimes its not even the constant drone of complaining/whining/bitching these patients bombard me with on a daily basis, its the lack of basic courtesy.  I expect a “thank you” after I save your ass from a drug interaction or getting that prior auth which your doctor would have never obtained on his/her own.  Instead I just get a complaint how I don’t have that $1000 special-order drug in stock even after I told you to give me a week to order it.  Its like I’m expected to be everyone’s mom/dad/babysitter and forget that the sole reason why I am there is to protect you from dying because you’re an idiot with your medications.

Now if you are paying cash for your medications, then you have the full right to bitch at me (as I have the full right to increase the price of your medications the next time you come in), but getting shit for free? Sorry, you have absolutely no room to bitch.  You are getting a handout from the generous taxpayers in your area, be grateful that we are forced to care for you.

Let me put it bluntly; If pharmacists weren’t around, you would of died by now due to a drug interaction or be dead from not getting the proper medication.  We save lives on a daily basis, and no matter how fucked your day/life/etc has been WE are not at fault, so show us some fucking courtesy like your dead-beat parents should of taught you and stop yelling at me for shit that’s 100% not my problem.  Go bitch at the EMTs for putting the IV line in your left arm instead of your right arm while you are bleeding out after that drunk driving accident instead of us.

All of this for $2 dispensing fee.  The kid who vacuums my car at the car-wash makes more in a tip than I do off of your Rx.

There is an inherit problem with having zero copays for our “less fortunate” friends.  Lets look at two cases.

Mary is a 35 year old single working mom.  Her ‘baby daddy’ left her high and dry when the going got tough.  By using daycare through her family, she is able to pull off a part time job and qualifies only for food stamps.  She is not eligible for full-scope welfare due to the inherit racism that goes on within the welfare system (yeah, I went there, ignoring it wont make it go away).  She forgoes the fancy cell-phone, cable-tv, and nice car to afford health insurance for her and her baby (which shes fine with, she views insurance as a necessary expense like food).  Her copays are $50/rx.

Jacob is a 45 year old male.  Due to heavy cocaine use during his youth he has congestive heart failure and as a result is unable to work (according to him and his quack doctor).  He recieves full-scope welfare complete with food-stamps and a check every month.  He spends his day harassing his pharmacy about refilling his pain-pills early and enjoys watching daytime TV.  His copay is $0/rx.

Both Mary and Jacob bring you an Rx for some Flovent.  Mary pays $50 and Jacob pays $0 for the same Rx.  Both leave your store drugs in hand.

A week later, Jacob calls you and says he lost his Flovent.  He has spend a whole 4 min’s looking for it and demands he gets a replacement at once.  Mary also calls you a week later.  She has torn her entire house apart looking for this Flovent and is reluctant to ask for a replacement Flovent at the cost of about $175.  Jacob is upset at YOU that the insurance wont pay for it early, and Mary is upset at HERSELF for losing something that cost her $50.

See where this is going?

There is a HUGE problem with giving people medications for free.  The problem is that once something is free, people see no value to it.  Sure Jacob lost a Flovent or Blood Glucose Monitor, but because to him its free, why should he spend any of his valuable time to actually look for it vs just calling and getting another one for free.  Mary has an incentive to tear her house apart (or call her insurance company) looking for the lost Flovent because it COST her $50.  Jacob is out nothing, and Mary is out something.  Jacob gets everything handed to him while Mary busts her ass.  Both are “in need”, but their reasons for being “in need” is another rant for another day.

Mary obviously places a value on her Rx’s.  Even if shes oblivious to the true cost of the medications (and how much her insurance company pays), shes quite aware to HER cost for those medications.  Jacob, on the other hand couldn’t care less how much his lost medication has cost the state because HIS cost is a whopping zero.  Who cares if he lost every medication on his profile in an act that was entirely his fault, he’s out nothing short of the inconvenience of driving to the pharmacy and picking them up again.  He wont have to choose medication or rent, and his check wont be impacted in the least.  Mary isn’t so lucky.

Lets put it this way; by getting drugs for $0, there is no negative-feedback/punishment/repercussions for losing medication.  Medication has a net-worth of $0 to them, and they don’t give two fucks what happens to their medication because their lives are not financially impacted by losing them.  If I spend $50 on something, and I misplace it, I’m sure a shit going to tear everything apart looking for it.  Is it the same if I spend $0 on something?

Think of this next time you fill that ER prescription for Tylenol and Robatussin DM.

Copays.

Probably the most confusing and frustrating concept in the pharmacy world.

The idea is simple.  You pay the pharmacy money to help pay for your drug, hence the word Co-Pay.  Like Cooperative Pay, you and your insurance company are joining forces to pay the pharmacy for the goods given to you.  If it were that simple then I wouldn’t have a website.

When I hear that I’m needed out front because a patient has a question about a copay, my GERD goes through the roof.  Not because the concept is hard, but I know that I’m going to get yelled at and blamed for something that is 100% not my responsibility, not my fault, and to be honest a whole truckload of not my fucking problem.  I’m a pharmacist, I make sure drugs don’t kill you, I don’t give a fuck about an issue between you and your insurance company.  Your insurance company says I need to collect $x, so the bill is $x.

The most frustrating (and that requires the most restraint on my part) is when people bitch that their copays got bumped up from $5 to like $15 for shit like Aciphex, Nexium, or some other drug that costs over $100.  I really have a hard time not taking their prescription back, running it out as cash, and saying “here ya go, pay that now you ungrateful stupid fuck”.  These people are stupid, and really dont get the concept that they are getting $150+ worth of medication for $15.  “I pay premiums I want my insurance to pay for all of it!” says the idiot who is getting about $500 worth of medication totaling $50 worth of copays with $200/month premiums.  You are getting MORE OUT than you are PUTTING IN and BITCHING ABOUT IT!!!! No wonder why this system is all broken.

Idiots on socialized plans (Medicare/Medicaid) are even worse, because their copays are like $3.10 which is MORE of a slap in the face when they bitch/cant pony the cash for their $200 worth of shit they probably don’t need.

Enbrel, $3.10 copay, cue the massive whining and bitching on how someone is on a “fixed income” and cant pay.  Enbrel is thousands of dollars for $3.10.  Three fucking ten.  You cant even buy a fucking value meal at McDonalds for $3.10!!! This fucking twat is whining at me for having to pay!!  I’m sorry honey, but that $3.10 is my whole profit from this Rx, so I’m not letting you pay me on the first.  Personal finance 101, make sure you have $3.10 for your Enbrel – Thank you.

I mean really, if you went to go and buy a TV at Best Buy that costs $400, and you threw a fit because you had to pay out of your own pocket $25 for this $400 TV, would you be upset if people called you stupid?  Would you be upset if the salesman said “Listen you fucking idiot, the rest of the world has to pay a whole fuckload more than you, and you’re whining about a measly $25 for a $400 product?!?”

Then there is this bullshit rumor that we set the copays.  If pharmacists could set insurance copays, then maybe the bitching and whining would have some merit.  However the HUGE FUCKING NON-SECRET is that PHARMACISTS DO NOT SET YOUR COPAYS (unless you are paying cash).  They are transmitted to us via computer and are set by the insurance company that YOU PAY (or we pay) TO PROVIDE YOU Rx COVERAGE.  Does the Taco Bell drive up teller set the price of your burrito?  NO! They punch a burrito into the computer and it spits out how much you need to pay.  Pharmacy is the exact same fucking thing, but people still don’t get it.

People want something or someone to bitch at because of their copays.  Yeah, that’s fine, but bitch at some Indian drone at Blue Cross, not me.

Sometimes I wonder why we even listen to what patients have to say.

How many times a day are you lied to by a patient.  A patient who on the phone will tell you they “lost” their medication, but when they magically show up at the store they say they are going to Mexico for 2 months. A patient who cried how his pain pills were stolen 2 days ago, yet is in the paper today for selling his prescriptions to an undercover officer.

Heres a colorful metaphor.  You have two sparkling clean containers (the doctor and the pharmacist).  One is filled with clean pure drinking water (the message) and must be moved to the other container.  How we join them? A piece of uncleaned retired sewage pipe (the patient).  Sure, water is going to get from one container to the other, but its going to pick up a whole lot of shit along the way.  However heres the kicker, some doctors listen to what these patients have to say as the absolute truth.

Example:  Doctor calls up the pharmacy pissed as hell because the patient said that the “bad pharmacist wouldn’t fill my pain pills”.  Doctor gives the pharmacist both barrels before being fed some humble pie by learning that his beloved patient got a month supply a week ago from another doctor.

Patients are horrible translators, historians, and message carriers.  How many times has a patient told you a message they recieved from the doctor (like to stop a medication), only to have it be horribly wrong?  How many times have you had patients spout medical jargon they learned from their doctor about their condition only to have it be sorta right in a ignore-the-big-picture sort of way?  Yet doctors and pharmacists use the patient to carry messages to each other.

“Contact myself or your doctor if your lisinopril gives you a bothersome cough” turns into “My pharmacist told me to stop my lisinopril because I coughed” and “Maybe you should ask your doctor about a pain management referral” turns into  “My pharmacist said that you should send me to a pain management doctor because you don’t know what you are doing”.  The shit that patients twist and fabricate with a single grain of truth just boggles my mind, and just makes bad blood between the doctors and the pharmacists.

What kills my soul (which a lot of things do, this being one of them), is when patients have a tiny-yet-dangerous bit of medical knowledge gained through the internet or one nursing class 15 years ago.  Then the bullshit they spout actually sounds like it really did come from the doctor or pharmacist even though its completely wrong.

So how to handle this?  Easy, treat the child like he’s a fucking 5 year old, and pin a note to his/her shirt to give to the doctor/pharmacist.