Behind the public image

magglassI was talking to one of the Pharmacist that works for a major chain that claims that they are so interested in your health that it is now part of their name.

It would seem that this chains concern about the health of their employees …is not as focused as their ads would suggest they are concerned about the community at large. Of course, they are wanting those in the community to come into their stores and spend their money… to help make this chain’s bottom line more “healthy”.

What I was told that in this particular – rather large sq ft – 24 hr store… during the overnight shift… there is one Pharmacist and one cashier – at the front register. IN THE ENTIRE STORE. Both employees are SENIOR CITIZENS !

I am told that the seasonal merchandise is stacked so high that the Pharmacist in the rear of the store… can’t see the cashier in the front of the store.

This store – like most retail stores – has video cameras covering most of the store..but.. neither of the employees has access to a monitor to view what is going on in the entire store.. I understand the monitor(s) are locked up in the manager’s office..

I just wonder how meal or rest room breaks are handled .. with just two employees in this large a store ?

I don’t know if this store has silent hold up button… but.. I know this corporation has a policy that no matter if an employee is properly licensed.. cannot carry a fire arm.. so whether it is a silent hold up button or phone call.. when seconds count… the cops are only minutes away …

So when the typical pharmacy has controlled medications in stock worth tens of thousands of dollars “on the street”… when is the last time you heard of someone robbing a pharmacy for CASH ?

You can come to your conclusion if this chain’s concern about a person’s health is extended to their employees or if all their promotions about “concern about your health” is more about their bottom line and less about your health…  After all.. they still sell alcohol/beer/liquor !

That light at the end of the tunnel IS A TRAIN !

mousetripBy now most everyone has probably heard that Hydrocodone (HCD) products are going to become C-II’s as of Oct 6th.. Many have heard that the DEA has stated that any HCD Rx written before Oct 6th and has authorized refills on them.. can be treated under the old law… until authorized refills are used or expires 6 months from written.

I have read where some Boards of Pharmacy (BOP) have stated that all refills expire as of Oct 6th… in their state.. they are not going to follow Federal law.

I attended a seminar last week where this issue was discussed and there are few more hurdles in those states that are following the Federal law..

* The pharmacy computer system has to allow refills on C-II’s.. Other than computers used in LTC that can allow refills on C-II’s , … software used in the community/retail pharmacy does not allow C-II to refilled.. since it has always been ILLEGAL to refills C-II’s. Once Oct 6th, hits and the HCD products classification in the computer’s database is changed to C-II… no refills will be allowed by the computer!

* The Pharmacist can not rewrite a HCD Rx that has authorized refills.. because then it would be a “new” Rx and fall under the rules for all C-II’s and must be signed by the prescriber.

* Presuming that you get past all those hurdles… when a pharmacy purchases more HCD products from the wholesaler the bottles will be marked as C-II’s and CANNOT be used to fill HCD Rxs under the old rules. However, the pharmacy can use the HCD products marked as C-III to fill HCD Rxs after Oct 6th… that are now C-II’s.

So pts and maybe prescribers.. have read the Federal law and (falsely) working on what they have read in the paper or elsewhere. Who knows if the DEA bureaucrats intentionally or unintentionally put forth these regulations.. either not understanding how the pharmacy system works.. or put out these “transition regulations” knowing full well that they could not be implemented by those in community pharmacy… Allowing the DEA to claim that they provided this “transition period” to prevent problems and when pharmacists and prescribers are over loaded and pts are being thrown into withdrawal… Guess who is going to catch all the HELL ? Presuming that most pts get a 30 days supply… This craziness could go on for 30 days.. starting Oct 6th…

For those Pharmacists that have been around for a while.. think back to Jan 1, 2006 when Medicare Part D started… and that transition….

WITCH HUNT ?

Jury reaches verdict in Dr. Daniel Baldi trial

From the article:

DES MOINES, Iowa —The jury announced its verdict Thursday in the trial of Dr. Daniel Baldi.

Watch video of this story

Baldi was charged with seven counts of involuntary manslaughter in the death of his patients.

The jury found Baldi not guilty on all counts.

The jury deliberated all day on Wednesday and 9 a.m. to about 3:45 p.m today to reach its decision.

He said he is not sure if he will continue practicing medicine.Baldi’s attorney, Guy Cook, said hundreds of Baldi’s former patients wanted to testify on his behalf, but Cook said he didn’t need their testimony because of the state’s failure of proof in the case.  Cook said every time the prosecution brought up another patient, the defense countered with the patient didn’t have drugs in their system when they died or Baldi hadn’t seen them in months or even years or were under another doctor’s care when they died.

DELIBERATIONS WEDNESDAY:

KCCI’s Mark Tauscheck reported that after 90 minutes of deliberating the jury had a question for the court. They asked, “Do we have full medical records for all seven patients? Is the prosecutions medical records selective records or the complete medical records during Dr. Baldi’s treatment?”

The answer is they are not complete records and are just selected records. The jury was officially told “You have the records that were offered and admitted into evidence for the seven patients.”

Be Careful buying that organic fertilizer

DEA & Shorewood Cops Raid Woman’s Home After She Shops at Indoor Garden Center

http://patch.com/illinois/shorewood-il/dea–shorewood-cops-raid-womans-home-after-she-shops-at-indoor-garden-center#.VB4gchaa_dV

From the article:

DEA agents rooted through a Shorewood woman’s garbage and stormed her home in an early morning raid after spotting her shopping at an indoor garden center they had been staking out.

The raid on Kirking’s house marked the culmination of a nearly month-long investigation that involved federal agents searching through her garbage and comparing her electric bill to those of a couple neighbors. In the end, police and prosecutors apparently believed they had enough to charge Kirking with nothing more than a pair of misdemeanors.

In a complaint for a search warrant, a DEA agent wrote that he was staking out Midwest Hydroganics on Sept. 17 because his previous surveillance there “led to the arrests of subjects for production of cannabis sativa plants and possession of cannabis.”

During his stakeout, the agent noticed Kirking “exit the front door of the store carrying a green plastic bag containing unknown items.”

Imagine this 21 century technology being used against 21 century crooks

badgehttp://www.protectpaincare.org/index.html

Pharmacovigilance Biometrics:

A Technological Advancement in the Management of Chronic Pain

DEA trying to intimidate members of Congress ?

DEA Official Reportedly Accused Lawmakers Of ‘Supporting Criminals’ For Backing This Bill

From the article:

A top Drug Enforcement Administration official reportedly accused sponsors of a prescription drug bill that unanimously passed the House of Representatives of “supporting criminals,” since the legislation would give pill distributors and pharmacists who are found to have violated regulations an opportunity to take corrective action before their registration was revoked or suspended.

Rep. Tom Marino (R-Pa.) said Thursday that Joseph Rannazzisi, who heads DEA’s Office of Diversion Control, had accused sponsors of the Ensuring Patient Access and Effective Drug Enforcement Act of 2013 of “supporting criminals.” Rannazzisi reportedly made the comments in late July, during a conference call with staffers from the Energy and Commerce Committee and Judiciary Committee before the legislation passed.

“It is my understanding that Joe Rannazzisi, a senior DEA official, has publicly accused we sponsors of the bill of ‘supporting criminals.’ This offends me immensely,” Marino said Thursday during a House Judiciary Committee hearing with DEA chief Michele Leonhart. “Such conduct is not acceptable and is unbecoming of the DEA, an agency that I have the utmost respect for.”

Imagine that… the word DEA and respect in the same sentence !

PROPaganda ?

One of my readers forwarded this to me… it was a email sent out by PROP (Physicians for Responsible Opioid Prescribing)

 

Dear Friends and Colleagues,

 

Here’s the latest from PROP:

 

  • Jane Ballantyne to become next President of PROP
  • September 28th FED UP! Rally on the Mall and march to the White House
  • The battle to up-schedule hydrocodone combos is over – Public health trumps special interests!
  • Chewable OxyContin is back with a new name- Targiniq ER

 

 

Dr. Jane Ballantyne to become next President of PROP

 

We are proud to announce that Dr. Jane Ballantyne will become the next President of PROP. The changing of the guard will occur on September 27th at the National Press Club in Washington, DC at the FED UP! Pre-rally reception (more about FED UP! Rally below).

 

Dr. Ballantyne received her medical degree from the Royal Free Hospital School of Medicine in London, England. She trained in Anesthesiology at the John Radcliffe Hospital, Oxford, England, before moving to the Massachusetts General Hospital (MGH), Harvard University in 1990, where she directed the Pain Center for 20 years. Dr. Ballantyne is UW Medicine Professor of Education and Research and has editorial roles in several leading journals and textbooks, and is a widely published author.

 

She was among the first prominent pain specialists in the country to sound the alarm about high dose chronic opioid therapy risks and lack of efficacy. She has an outstanding international reputation and is highly regarded for her research, writing, and professionalism. PROP is very lucky to have her as our next President!

 

In case you’re wondering… I’m not going away. On September 27th, I’ll become the Director of PROP, which allows me to remain actively involved in our advocacy and educational efforts.

 

 

Sunday, September 28th FED UP! Rally on the Mall and march to the White House

 

In case you haven’t heard, thousands of people from around the country will descend on Washington for a rally on the National Mall & a march to the White House. Together, we will call for an immediate and coordinated federal response to the opioid epidemic. The event was organized by a coalition of organizations (including PROP). If you’re feeling “FED UP!” with the tragically ineffective federal response to the opioid crisis, please try to be there and/or please spread word about the event.

 

To learn more about the FED UP! Rally and Platform, and to register please visit: www.feduprally.org

 

 

The battle to up-schedule hydrocodone combos is over – Public health trumps special interests!

 

On October 6, hydrocodone combos (i.e. Vicodin, Lortab & Norco) will move from C III to C II. PROP began advocating for this change when we first formed. This was a long hard fight against vested special interest groups and the FDA. We would not have won without the help of Congress (especially Senator Manchin) who passed legislation requiring FDA to hold an advisory committee meeting on the subject (the committee voted overwhelmingly in favor of the change). And we would not have won without support from the many medical experts and consumer advocates who submitted comments to the federal docket and gave testimony before the FDA advisory committee. THANK YOU!!!

 

It will take a few years before the impact of this change can be measured, but I’m hopeful it will mark a turning point in the opioid addiction epidemic. Up-scheduling will, no doubt, lead to a sharp decline in prescribing of hydrocodone combos, which in turn should lead to a sharp decline in new cases of opioid addiction (among both pain patients and recreational users).  Preventing opioid addiction is a must if we hope to bring the epidemic under control.

 

 

Chewable OxyContin is back with a new name- Targiniq ER

Last month FDA approved Purdue’s new extended-release opioid called Targiniq ER, which contains oxycodone combined with naloxone. FDA is allowing the drug to be marketed as “abuse-deterrent” because the naloxone may deter misuse by injection and snorting. However, naloxone has no effect on the brain when taken orally. This means that when chewed, extended-release Targiniq ER tablets will immediately release the entire dose of oxycodone – the naloxone will have no effect.

An FDA advisory committee (AC) would probably have voted against Targiniq ER approval because it has the same active ingredient (oxycodone) found in crush-resistant OxyContin but it’s obviously more dangerous. Rather than bringing it to an AC for a vote and risking another Zohydro fiasco, FDA bypassed its outside advisors and approved the drug without a vote. Purdue Pharma will once again have an easily chewed extended-release oxycodone product on the market.

If this has you feeling fed up with FDA, I hope we see you in Washington, DC for the FED UP! Rally. It will be very hard for the administration to ignore thousands of people marching from the National Mall to the White House, calling for a change at FDA and for an immediate and coordinated federal response to the opioid crisis.

Sincerely,

-Andrew

Andrew Kolodny, MD

President,

Physicians for Responsible Opioid Prescribing

www.supportPROP.org

 

Chief Medical Officer/SVP

Phoenix House Foundation

164 W. 74th Street

New York, NY 10023

T 347 396 0369

F 347 396 0370

akolodny@phoenixhouse.org

 

What is more important your ethics or fear of the DEA ?

One of my readers furnished me the following…  It is the American Medical Assoc CODE OF ETHICS ! I have highlighted in YELLOW 

the most important parts of this..

I see this being useful in two different means… First chronic pain or subjective disease pts have trouble with their physician adequately treating their disease issues.. and ask him/her if they believe/follow this code of ethics…

Secondly, after properly documenting a prescriber not following this code of ethics… use the documentation and this code of ethics to file complaints with the state Medical Licensing Board and Medicare/Medicaid/Insurance.

AMA Code of Ethics – 2004. Editorially Revised 2006

20/11/2006
Members are advised of the importance of seeking the advice of colleagues should they be facing difficult ethical situations.

Preamble

The AMA Code of Ethics articulates and promotes a body of ethical principles to guide doctors’ conduct in their relationships with patients, colleagues and society.

This Code has grown out of other similar ethical codes stretching back into history including the Hippocratic Oath.

Because of their special knowledge and expertise, doctors have a responsibility to improve and maintain the health of their patients who, either in a vulnerable state of illness or for the maintenance of their health, entrust themselves to medical care.

The doctor-patient relationship is itself a partnership based on mutual respect and collaboration. Within the partnership, both the doctor and the patient have rights as well as responsibilities.

Changes in society, science and the law constantly raise new ethical issues and may challenge existing ethical perspectives.

The AMA accepts the responsibility for setting the standards of ethical behaviour expected of doctors.

1. The Doctor and the Patient

1.1 Patient Care

Consider first the well-being of your patient.
Treat your patient with compassion and respect.
Approach health care as a collaboration between doctor and patient.
Practise the science and art of medicine to the best of your ability.
Continue lifelong self-education to improve your standard of medical care.
Maintain accurate contemporaneous clinical records.
Ensure that doctors and other health professionals upon whom you call to assist in the care of your patients are appropriately qualified.
Make sure that you do not exploit your patient for any reason.
Avoid engaging in sexual activity with your patient.
************
Refrain from denying treatment to your patient because of a judgement based on discrimination.
•••••••••••••••••••
Respect your patient’s right to choose their doctor freely, to accept or reject advice and to make their own decisions about treatment or procedures.
Maintain your patient’s confidentiality. Exceptions to this must be taken very seriously. They may include where there is a serious risk to the patient or another person, where required by law, where part of approved research, or where there are overwhelming societal interests.
Upon request by your patient, make available to another doctor a report of your findings and treatment.
******************************
Recognise that an established therapeutic relationship between doctor and patient must be respected.

********************************
Having initiated care in an emergency setting, continue to provide that care until your services are no longer required.
When a personal moral judgement or religious belief alone prevents you from recommending some form of therapy, inform your patient so that they may seek care elsewhere.
Recognise that you may decline to enter into a therapeutic relationship where an alternative health care provider is available, and the situation is not an emergency one.
*****************
Recognise that you may decline to continue a therapeutic relationship. Under such circumstances, you can discontinue the relationship only if an alternative health care provider is available and the situation is not an emergency one. You must inform your patient so that they may seek care elsewhere.
•••••••••••
Recognise your professional limitations and be prepared to refer as appropriate.
Place an appropriate value on your services when determining any fee. Consider the time, skill, and experience involved in the performance of those services together with any special circumstances.
Ensure that your patient is aware of your fees where possible. Encourage open discussion of health care costs.
When referring your patient to institutions or services in which you have a direct financial interest, provide full disclosure of such interest.

***************************
If you work in a practice or institution, place your professional duties and responsibilities to your patients above the commercial interests of the owners or others who work within these practices.

**************************
Ensure security of storage, access and utilisation of patient information.
**********************
Protect the right of doctors to prescribe, and any patient to receive, any new treatment, the demonstrated safety and efficacy of which offer hope of saving life, re-establishing health or alleviating suffering. In all such cases, fully inform the patient about the treatment, including the new or unorthodox nature of the treatment, where applicable.
*************************
1.2 Clinical Research

Accept responsibility to advance medical progress by participating in properly developed research involving human participants.
Ensure that responsible human research committees appraise the scientific merit and the ethical implications of the research.
Recognise that considerations relating to the well-being of individual participants in research take precedence over the interests of science or society.
Make sure that all research participants or their agents are fully informed and have consented to participate in the study. Refrain from using coercion or unconscionable inducements as a means of obtaining consent.
Inform treating doctors of the involvement of their patients in any research project, the nature of the project and its ethical basis.
Respect the participant’s right to withdraw from a study at any time without prejudice to medical treatment.
Make sure that the patient’s decision not to participate in a study does not compromise the doctor-patient relationship or appropriate treatment and care.
Ensure that research results are reviewed by an appropriate peer group before public release.
1.3 Clinical Teaching

Honour your obligation to pass on your professional knowledge and skills to colleagues and students.
Before embarking on any clinical teaching involving patients, ensure that patients are fully informed and have consented to participate.
Respect the patient’s right to refuse or withdraw from participating in clinical teaching at any time without compromising the doctor-patient relationship or appropriate treatment and care.
Avoid compromising patient care in any teaching exercise. Ensure that your patient is managed according to the best-proven diagnostic and therapeutic methods and that your patient’s comfort and dignity are maintained at all times.
Where relevant to clinical care, ensure that it is the treating doctor who imparts feedback to the patient.
Refrain from exploiting students or colleagues under your supervision in any way.
1.4 The Dying Patient

Remember the obligation to preserve life, but, where death is deemed to be imminent and where curative or life-prolonging treatment appears to be futile, try to ensure that death occurs with dignity and comfort.
******************
Respect the patient’s autonomy regarding the management of their medical condition including the refusal of treatment.
***********************

Respect the right of a severely and terminally ill patient to receive treatment for pain and suffering, even when such therapy may shorten a patient’s life.
Recognise the need for physical, psychological, emotional, and spiritual support for the patient, the family and other carers not only during the life of the patient, but also after their death.
1.5 Transplantation

Recognise that a potential donor is entitled to the same standard of care as any other patient.
Inform the donor and family fully of the proposal to transplant organs, the purpose and the risks of the procedure.
Exercise sensitivity and compassion when discussing the option to donate organs with the potential donor and family.
Refrain from using coercion when obtaining consent to all organ donations.
Explain brain death to potential donor families. Similarly explain that continued artificial organ support is necessary to enable subsequent organ transplantation.
Ensure that the determination of the death of any donor is made by doctors who are neither involved with the transplant procedure nor caring for the proposed recipient.
Recognise the important contribution donor families make in difficult circumstances. Ensure that they are given the opportunity to receive counselling and support.
2. The Doctor and the Profession

2.1 Professional Conduct

Build a professional reputation based on integrity and ability.
Recognise that your personal conduct may affect your reputation and that of your profession.
Refrain from making comments which may needlessly damage the reputation of a colleague.
Report suspected unethical or unprofessional conduct by a colleague to the appropriate peer review body.
Where a patient alleges unethical or unprofessional conduct by another doctor, respect the patient’s right to complain and assist them in resolving the issue.
Accept responsibility for your psychological and physical well-being as it may affect your professional ability.
Keep yourself up to date on relevant medical knowledge, codes of practice and legal responsibilities.
2.2 Advertising (editorially revised in November 2006)

Confine advertising of professional services to the presentation of information reasonably needed by patients or colleagues to make an informed decision about the availability and appropriateness of your medical services.
Make sure that any announcement or advertisement directed towards patients or colleagues is demonstrably true in all respects. Advertising should not bring the profession into disrepute.
Do not endorse therapeutic goods in public advertising.
Exercise caution in endorsing non-therapeutic goods in public advertising.
Do not have any public association with products that clearly affect health adversely.
Ensure that any therapeutic or diagnostic advance is described and examined through professional channels, and, if proven beneficial, is made available to the profession at large.
2.3 Referral to Colleagues

Obtain the opinion of an appropriate colleague acceptable to your patient if diagnosis or treatment is difficult or obscure, or in response to a reasonable request by your patient.
When referring a patient, make available to your colleague, with the patient’s knowledge and consent, all relevant information and indicate whether or not they are to assume the continuing care of your patient during their illness.
When an opinion has been requested by a colleague, report in detail your findings and recommendations to that doctor.
Should a consultant or specialist find a condition which requires referral of the patient to a consultant in another field, only make the referral following discussion with the patient’s general practitioner – except in an emergency situation.
3. Professional Independence

In order to provide high quality healthcare, you must safeguard clinical independence and professional integrity from increased demands from society, third parties, individual patients and governments.
Protect clinical independence as it is essential when choosing the best treatment for patients and defending their health needs against all who would deny or restrict necessary care.
Refrain from entering into any contract with a colleague or organisation which may conflict with professional integrity, clinical independence or your primary obligation to the patient.
Recognise your right to refuse to carry out services which you consider to be professionally unethical, against your moral convictions, imposed on you for either administrative reasons or for financial gain or which you consider are not in the best interest of the patient.
4. The Doctor and Society
******************
Endeavour to improve the standards and quality of, and access to, medical services in the community.
Accept a share of the profession’s responsibility to society in matters relating to the health and safety of the public, health education and legislation affecting the health of the community.
••••••••••••••••••••
Use your special knowledge and skills to minimise wastage of resources, but remember that your primary duty is to provide your patient with the best available care.
Make available your special knowledge and skills to assist those responsible for allocating healthcare resources.
Recognise your responsibility to give expert evidence to assist the courts or tribunals.
When providing scientific information to the public, recognise a responsibility to give the generally held opinions of the profession in a form that is readily understood. When presenting any personal opinion which is contrary to the generally held opinion of the profession, indicate that this is the case.
Regardless of society’s attitudes, ensure that you do not countenance, condone or participate in the practice of torture or other forms of cruel, inhuman, or degrading procedures, whatever the offence of which the victim of such procedures is suspected, accused or convicted.
References:

1. Canadian Medical Association (1996). Code of Ethics of the Canadian Medical Association.

2. World Medical Association International Code of Medical Ethics, as amended by the 35th World Medical Assembly, Venice, Italy, October 1983.

3. World Medical Association Declaration on the Rights of the Patient, as amended by the 47th WMA General Assembly, Bali, Indonesia, September 1995.

4. World Medical Association Declaration of Helsinki, as amended by the 52nd WMA General Assembly, Edinburgh, Scotland, October 2000.

5. World Medical Association Statement on Human Organ & Tissue Donation and Transplantation, adopted by the 52nd WMA General Assembly in Edinburgh, Scotland, October 2000.

6. World Medical Association Declaration with Guidelines for Continuous Quality Improvement in Health Care, as adopted by the 49th World Medical Assembly, Hamburg, Germany, November 1997.

Apparently all those gift cards given to unhappy people is not working !

Readers_Digest_Trusted_Brands_Survey_2013Metrics started in Pharmacy abt 8 yrs ago.. over the last 8 yrs… more and more Pharmacists and Physicians are now employees of some BIG CORPORATION… Medicare/Medicaid/Insurance is now starting to measure some metrics…  Are all the metrics that we are trying to meet… distracting from pt care and pt satisfaction  and this survey demonstrates that ?

Off the pain scale ?