What’s your goal

Posted on April 29, 2022 by Pharmaciststeve

Chronic pain pts are often advised never to ask the practitioner for a particular medication or strength  for fear that they will be viewed as a “drug seeker”.  When a pt goes to a doc’s office – regardless if it is a PCP or some specialist…  If the pt’s labs are outside of normal ranges, the prescriber should automatically have a “goal” to prescribe some sort of therapy to enable the pt to get their labs back into what is considered a “normal range”

Maybe it should be suggested to chronic pain pts to their pain doc… what on the 1-10 pain scale is his/her goal for you.  After all you are seeing a PAIN SPECIALIST… does this specialist believe that he/she is comfortable with their pts having to LIVE or EXIST in a pain level > 5 most all of the time ?   Some believe that level of pain is – or should be considered – a torturous level of pain.

Opiates are one very few meds that doesn’t have a relative predictable LD50 – LD50 is a dose when given to a number of pts, 50% will die. One of the first thing that the body becomes tolerate to when a pt takes a opiate every day – and that is respiratory suppression.

This explains why opiate naive people that take some illegal fentanyl, they DIE FROM RESPIRATORY SUPPRESSION.

I would suspect that any pt asking a pain doc what level of pain was his/her goal for the pt and gets a very vague or gets something like…  we will have to see how things progress… would strongly suggest that the pt’s therapy and pain management outcomes will be more dependent on the pt’s opiate doses reach some MME/day limit that the physician believes is a hard daily limit.

If the prescriber has not done any testing for opiate metabolism rates using the CYP-450 opiate metabolism test or the PGx (pharmacogenomics) test… both of these tests are simple cheek swab or “spit in a tube” test.  If the pt is given the choice, I would chose the latter, it is a much more comprehensive test and will give the prescriber much more information about the pt’s metabolism.

If the prescriber has reached his/her daily MME limit and the pt’s pain intensity is still >5, then the pt has to either accept living in a torturous level of pain or if the practitioner has not ran one of the DNA metabolism tests – the pt might want to ask as to why not ?  ask the practitioner if they had the DNA test run, and the pt was shown to be a fast/ultra fast metabolizer… would the prescriber even increase the pt’s dose ?   If the answer is NO… then the pt has to decide if they wish to continue to live in a torturous level of pain or have the DNA test run themselves and if it demonstrates that they are a fast/ultra fast metabolizer.  Attempt to find a practitioner that will take those DNA test in consideration when determining how much opiates they would be willing to prescriber for you.

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national pain council project

Posted on April 29, 2022 by Pharmaciststeve

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Biden Admin: creating Disinformation Governance Board under HDS

Posted on April 29, 2022 by Pharmaciststeve

Disinformation Head Nina Jankowicz

 

The first video is of the person that Biden has appointed to head this new Disinformation Governance Board, One of her most infamous declaration of disinformation was that Hunter Biden laptop was “We should view it as a Trump campaign product ”  in this article https://www.msn.com/en-us/news/politics/disinformation-head-nina-jankowicz-addresses-hunter-biden-laptop-remarks/ar-AAWGM7G     This quote was Oct 15,2020 – just before the Nov election.  And the Delaware AG is currently convening a grand jury hearing on Hunter Biden various questionable activities – including his laptop. https://delawarebusinessnow.com/2022/03/delaware-u-s-attorneys-investigation-of-hunter-bidens-business-dealings-continues/  It has also been stated that because this Disinformation Governance Board is placed within/under a Presidential cabinet position,  BY LAW – Congress has NO OVERSIGHT ON WHAT IT DOES.

I posted yesterday this saterial video from the @TheBabylonBee https://www.pharmaciststeve.com/some-people-may-view-this-as-extremely-political-i-am-lmao/  concerning Eldon Musk and him buying TWITTER and Twitter’s become a FREE SPEECH platform.  Who believes that this disinformation governance board will “call out” the DEA and the CDC about the DISINFORMATION on our opiate crisis ? And we are on top of the primary voting season and we are just SIX MONTHS from the mid-term elections.

 

 

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Some people may view this as extremely political – I am LMAO

Posted on April 28, 2022 by Pharmaciststeve


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How your health insurance can possibly be OVERCHARGING you on your Rx medications

Posted on April 28, 2022 by Pharmaciststeve

https://www.facebook.com/pharmaciststeve/posts/10227166972189416

SoWal Health & Drug

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Today I saved a patient a combined $200 ( yes, TWO HUNDRED DOLLARS!) on their 3 prescription medications. Their insurance copays THAT ARE SET EXCLUSIVELY BY THE INSURANCE COMPANY ( we don’t have any input on copays) were $110,$90 & $80 while my price without insurance for the 3 medications were $20, $20 & $30. Many of you will be surprised to learn that on many generic medicines your price without insurance can be less than your insurance copay or an accumulation of copays ESPECIALLY IF YOU ARE SELF INSURED!
When you factor in your monthly insurance premiums those costs for medications are even more expensive than just the inflated copays. If you want a price quote just text me at 850-797-2711 and I’ll do my best to respond ASAP. #sowalrx PRICING AS TRANSPARENT AS THE EMERALD BLUE WATER!
this is an example how a independent pharmacy/Pharmacist watch out for their pt’s both HEALTH AND POCKETBOOK. At one time, the major PBM’s (prescription benefit managers) had in their contracts with pharmacies that it was a contract violation if a Pharmacist told the pt that the pharmacy’s cash price was LESS THAN what the PBM wanted as copays  — UNLESS the pt asked if the pharmacy’s cash prices was lower..
Thank goodness, our Congress finally did something right and passed a law that made having such clauses in those PBM pharmacy contracts ILLEGAL and pts like this one, the pharmacist/pharmacy was able to save the pt abt $200.
This graph shows an example of where most of the money goes that you pay at the Rx dept register. Nearly 50% goes into the pockets of MIDDLEMEN – who provide no product or service that provides any real contribution to pt’s health, well being and QOL.
Anyone not using a independent pharmacy, who would like to find one to patronize, there is a hyperlink to find one by zip code https://ncpa.org/pharmacy-locator  This database is maintained by a the National Community Pharmacist Association – whose membership is almost exclusively those who work or own independent pharmacies and has been around since 1898 and I have been a member of since 1983.

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I heard it through the GRAPEVINE

Posted on April 27, 2022 by Pharmaciststeve

It is a pretty accepted fact that the chronic pain community is – and has been – very divided… It seem that a small group of people who claim to be chronic pain pts and/or chronic pain advocates have been very busy at work trying to be more than just the “usual stuff” starting late summer – early fall last year. First it my blog getting labeled as a SPAMMER by FACE BOOK… some even made up stories about another chronic painer being the reason behind my blog being labeled as a SPAMMER.  Then there was the APDF protest in DC  last fall and one of the BOD members had done a TV interview with all three station in DC…  and some people called the station the day before the protest and told the newsroom that the protest was actually a PLANNED MASS SUICIDE and the interviews done…. were never aired…

During that same time frame, these same people, started calling and email one of the highly visible chronic pain pt’s pain doctor and apparently fabricating so many lies about the pt… that the pt was discharged from the pain practice that the pt had been going to for 27 yrs.

The question has to be asked, are these people who are putting themselves forward as pain pts and/or pain advocates or are they really just shills. What legit chronic pain pt goes out their way and fabricate lies/stories to try and get a chronic pain pts toss out of their pain clinic… knowing how difficult it is for a intractable chronic  pain pt to get into a new clinic. IMO… that has to done only by some people with a very depraved mind set.

IMO… it may get worse from here… have you noticed that there are a few “pain advocates” have been in hyper-mode…  talking about pts getting some severe side effects from using certain medications, or promoting some products for chronic painers to get/take when they have had their pain meds taking away…

Just be careful who you give your personal information to…  if someone is pushing a product, or you get a phone call from some law firm about physical damages you have experienced from taking one or more particular prescription medication(s) or you are “hooked-up ” with some entity selling some supplement that some claim helps with pts dealing with chronic pain or you are contacted by some entity – like a university – that is starting a new “pain study”…  because someone has gotten PAID to share your name/personal information or if you have purchased some product that they were pushing.

You may think that is perfectly OK for someone to monetize the selling of your personal information without your permission, but some of these individuals may be more interested in advocating for the money in their bank account.

Full disclosure: In the ten+ years I have had a active blog and advocating for chronic pain pts, my goal has always been to educate and motivate the chronic pain pt to advocate for themselves. I have NEVER requested money from pts that have sought out my advice, I have even turn down some of who have offered to pay me, I have never shared nor sold any personal pt information to any entity for my personal financial gain.  After this post is published, I expect that some of these “chronic pain advocates” to come after me…  I went to pharmacy school to help people and even though I am retired, I follow what I believe is my true advocacy.

 

 

 

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21st century healthcare: Medical McCarthyism, when errors become crimes

Posted on April 26, 2022 by Pharmaciststeve

Until COVID-19 became a issue, historically… medical errors was the third largest cause of death. After Cancer and cardiovascular. Has the DOJ and our judicial system got a “taste of blood” as more and more prescribers are being taken to court over mostly fabricated violations of the Controlled Substance Act.  As more and more District Attorneys are refusing to charge many criminals, is those in our judicial system just looking for any case that they can justify their paycheck ?

Selective Outrage in Healthcare, RaDonda Vaught vs. William Husel

https://www.daily-remedy.com/selective-outrage-in-healthcare-radonda-vaught-rn-vs-william-husel-do/

We lie all the time.

We pretend to care about things we really do not and we pretend not to care about things that we really do. We have no consistent parameters guiding our behavior.

We watch identical acts of injustice or see similar tragedies unfolding and have vastly different perceptions. Behavioral economists call this the empathy gap.

We underestimate the influence of subjective beliefs on our own behavior and make decisions that only satisfy our current perceptions. It explains why the loss of European lives in Ukraine attracts greater media attention than the loss of lives of Central Asians in Afghanistan. This is not a new phenomenon.

But it appears in healthcare in uniquely unprecedented ways. The increasing government encroachment into healthcare has led to a slew of highly publicized criminal cases that were previously addressed more privately as regulatory concerns. Now medical errors are criminal acts.

This may be tragic enough, but our wavering response to these tragedies adds a veneer of shame to a dark time in healthcare, and will prove to be an indelible stain on our medical history.

Recently, a nurse in Tennessee named RaDonda Vaught was convicted for murder for what otherwise would be deemed a medical error. While a fatal error, it was an error nonetheless, that took place over the course of patient care. It should have been handled by the state’s medical licensing board and nurse oversight committees.

Instead, local prosecutors took it upon themselves to indict and inflict a vicious display of retaliatory justice in which Vaught found herself convicted by a jury for a medical error. The ramifications were quick and powerful.

Nurses all over the country shouted in protest. Nurses quit. The American Nurses Association issued a statement of concern:

“The nursing profession is already extremely short-staffed, strained and facing immense pressure – an unfortunate multi-year trend that was further exacerbated by the effects of the pandemic. This ruling will have a long-lasting negative impact on the profession.”

The outrage in support for Vaught was commendable. It shows a strong sense of solidarity in support of one healthcare worker. Such displays of support are sorely needed. And have strong reason to believe the government encroachment that led to Vaught’s conviction will be challenged. We likely have not heard the last of this case.

What we have not heard of is another ruling, that of an acquittal, for a physician who was indicted for prescribing fentanyl as a form of palliative care for hospice patients under his care. Dr. William Husel was indicted on fourteen counts of murder for treating patients with fentanyl to relieve their pain in the last days of their lives.

He violated no protocol. He adhered to clinical standards of care. He simply prescribed fentanyl at a dose that a non-medically trained prosecutor somehow believed to be excessive and therefore criminal. There was no clinical or legal basis for the charges. Yet he was made to endure a two month trial for what amounts to practicing clinical medicine.

Yet there is no outrage against the prosecutors in this case. No congratulatory support for the physician who risked life imprisonment to challenge bogus claims of criminality.

Why the glaring difference in response from the public?

At least in the cause of Vaught, an error took place. But Dr. Husel committed no error and ensured a pain-free quality of life for patients at the end of their lives. We clamor for justice in one case, and remain silent for the other.

This is what the empathy gap looks like in healthcare. And it is why little has been done to reign in government encroachment in healthcare. We have no consistent response to individual acts of injustice and therefore no consistent means of challenging government misconduct. Shakespeare recognized as much centuries ago when he wrote the following lines in The Merchant of Venice:

If you prick us, do we not bleed?

If you tickle us, do we not laugh?

If you poison us, do we not die?

The lines allude to the lack of compassion we hold for some but carry in abundance for others. It shows how empathy waxes and wanes and leads to different reactions to similar events. It is why Vaught’s conviction led to national outrage and why Husel’s acquittal hardly registered a blip on the national radar.

Healthcare is facing unprecedented pressure from a government encroaching more and more into healthcare. It has induced a state of fear and artificial conformity – a veritable state of Medical McCarthyism.

It manifests when we see errors become crimes. Yet, our inconsistent responses have allowed this to go on. We feign selective outrage when we see someone we can relate to being attacked. We ignore or show disdain when we see someone we cannot relate to being attacked.

Accordingly, our perceptions flutter. Of course, the physician deserved to be indicted. Of course, the physician got away with it. But the poor nurse, she must be a victim. Even if she made an error, she should not be criminalized for an error that could have happened to anyone.

We attribute systemic errors to the individual when convenient. And we remember the nuance in systemic problems when we can identify with the individual. There are no consistent parameters in our response.

It all depends on the perceptions we hold, fluttering amidst the winds of outrage, emerging out of the void of the unknown, where we find the empathy gap.

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East Brady woman sues CVS over face mask dispute

Posted on April 25, 2022 by Pharmaciststeve


East Brady woman sues CVS over face mask dispute

https://www.butlereagle.com/20220425/east-brady-woman-sues-cvs-over-face-mask-dispute/

An East Brady woman has filed a lawsuit against CVS alleging she had no alternative but to resign because the company would not allow her to wear a face shield instead of a face mask that caused her to faint.

Through her attorney, Brittany Beham filed the suit in Butler County Common Pleas Court against Pennsylvania CVS Pharmacy, LLC, which operates the CVS inside the Target in Butler Commons in Butler Township where she worked as a pharmacy intern from March 2016 to September 2020, according to the suit.

Beham suffers from panic disorder with syncopal, or fainting episodes, and experienced several episodes from March through June of 2020 as a result of wearing a face mask, according to the suit.

During that time, she claims that she told her supervisor on several occasions that wearing a mask was causing the episodes. While on short-term disability leave from June 18 to July 21, 2020, she was treated by a therapist, but could not take anti-anxiety medicine because she was pregnant, according to the suit.

She completed and submitted a reasonable accommodation questionnaire, asking for permission to wear a face shield instead of a mask to prevent further episodes, and submitted a note from a nurse at Butler Health System Women’s Care Associates, saying she cannot wear a mask due to the episodes, but she can wear a shield.

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Pfizer recalls some batches of blood pressure drug over carcinogen presence

Posted on April 24, 2022 by Pharmaciststeve

Pfizer recalls some batches of blood pressure drug over carcinogen presence

Pfizer has yet to receive any reports of adverse effects related to the recalled batches

https://www.foxbusiness.com/healthcare/pfizer-recalls-batches-blood-pressure-drug-carcinogen

Pfizer said Friday it was voluntarily recalling five batches of its Accupril blood pressure tablets after finding elevated levels of a potential cancer-causing agent in the medicine.

The drugmaker said it was not aware of any reports of adverse events related to the recalled batches, which were distributed in the United States and Puerto Rico from December 2019 to April 2022.

Pfizer Canada also recalled all lots of three doses of Accupril Thursday after finding the same impurity to be above acceptable levels.

Pfizer said there was no immediate risk to patients taking this medication, in which the agent, a nitrosamine, was found.

 Exterior view of a Pfizer building in Berlin.  (Ulrich Baumgarten via Getty Images / Getty Images)

Nitrosamines are common in water and foods, but exposure above acceptable levels over long periods of time could increase the risk of cancer.

Pfizer last month also recalled some batches of another blood pressure drug, Accuretic, and two authorized cheaper versions due to the presence of the possible carcinogen.

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Japan’s Shionogi says COVID-19 pill shows rapid clearance of virus

Posted on April 24, 2022 by Pharmaciststeve

Japan’s Shionogi says COVID-19 pill shows rapid clearance of virus

The company has global aspirations for the antiviral pill

https://www.foxbusiness.com/healthcare/japans-shionogi-says-covid-19-pill-shows-rapid-clearance-virus

An experimental treatment from Shionogi & Co. Ltd. has shown rapid clearance of the virus that causes COVID-19, according to new data, the Japanese drugmaker said Sunday.

The pill, S-217622, “demonstrated rapid clearance of the infectious SARS-CoV-2 virus,” Shionogi said in a statement, citing results from a clinical trial of the drug.

The company has global aspirations for the antiviral pill, which is now being evaluated by Japanese regulators.

The findings released Sunday also showed “there was no significant difference in total score of 12 COVID-19 symptoms between treatment arms,” although the drug showed improvement in a composite score of five “respiratory and feverish” symptoms, Shionogi said.

 A ground crew member moves pallets of a shipment of Pfizer’s antiviral COVID-19 pills, Paxlovid, as they arrive at an Incheon International Airport cargo terminal Jan. 13, 2022, in Incheon, South Korea. ( Jung Yeon-Je, Pool/Getty Images / Getty Images)

The drugmaker said in March it would launch a global trial for the drug with U.S. government support, and Chief Executive Isao Teshirogi has said production could reach 10 million doses a year.

Shionogi’s shares have been on a roller coaster on speculation about success of the treatment. The stock climbed Friday after a report the U.S. government is in talks to acquire supplies of the drug.

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