-=+=-

I understand the Unites States requires every pharmacist to get a doctorate prior to becoming qualified. However, in Australia, it isn’t required. It is still an undergraduate degree, so we come out after only four years of studying, do a year’s internship, pass our registration exams and we’re done. Every year, we have to enough “points” every year to remain registered as a way to encourage our ongoing learning.

As I’m still in my third year of my degree at the wonderful University of Sydney, we are required to undertake externships, where we get sent to pharmacies for “workplace experience”. I undertook my externship at a medical centre in Sydney’s north.

As one would presume, the entire purpose of my presence there was to learn. The medical centre pharmacy was small enough for only one pharmacist and pharmacist assistant to run the store.

I was questioning the pharmacist present at the time of the several of the drugs people came in for. One of them was quetiapine- as one should know- an atypical antipsychotic.

“What class of antipsychotic is quetiapine?” I asked.

The pharmacist replied curtly, “I don’t know.”

At that time, the pharmacist assistant, who is also qualified, hospital nurse, commented that he should know coz he just passed his registration exams a few months ago.

So I continued to ask: “Why do antipsychotics cause suicidal thoughts at times?”

“I don’t know.”

 Do you fucking know anything?

Let’s try something else then. “Why do topical corticosteroids thin out the skin?”

“I don’t know.”

How much did you bribe the examiner to let you pass your registration exams?!

Ok, so I dropped that topic. So I asked about shingles. “I heard shingles is called herpes zoster, but it’s caused by the varicella virus. So does that mean herpes and varicella virus are the same?”

Again, “I don’t know.”

The pharmacist did not look at me the entire time, so I looked at the computer screen he was typing away at. He was on Wikipedia searching up shingles.

WIKIPEDIA.

SURELY, THERE ARE MORE RESPECTABLE & TRUSTWORTHY REFERENCES TO TURN TO? ALL OF THEM HAVE AN ELECTRONIC VERSION AVAILABLE. MEDSCAPE. AUSTRALIAN MEDICINES HANDBOOK. MIMS ONLINE. THERAPEUTIC GUIDELINES.

“I don’t know anything. Stop asking me questions.”

That’s exactly what I did. So for the rest of my externship that day, I didn’t ask any questions. This incompetent pharmacist went on to report me with an “attitude, and is not willing to learn”.

Oh wait, what? So did not see that one coming.

I have seen a variety of pharmacists in the professional field over the three years I’ve been studying and working in pharmacies. I’ve seen the best pharmacists who are able to treat palmoplantar  psoriasis and various skin conditions better than doctors can. I’ve also seen the negligent; one pharmacist gave out Nurofen Plus to a patient with an active peptic ulcer just because they requested it by brand.  Even with my incomplete education, I know that I should have offered an alternative, perhaps paracetamol [acetaminophen] for your headache?

The pharmacist I worked with during my externship rivals the worst pharmacists simply due to his knowledge gap. I don’t think customers realise it because all he does is assume the doctor has given all the instructions to the patient, so he doesn’t have to do it, and most customers are regulars so they’ve been on the medications for many years.

Being a young pharmacist isn’t an excuse for being ignorant. Pharmacists are the second most respected profession [second only to emergency workers] so don’t tarnish our reputation!

2. Had a very rotund person (never seen her before -- so not a regular) came in and ask me about getting a shingles vaccine as she did not want to catch it from any of her friends. I told her that it was in no way contagious. She goes on to say that 2 or 3 of her friends have it or have had it and that her doctor told her that "IT. WAS. CONTAGIOUS!" I told her that "I will back off my previous statement a very small bit -- If a person comes into contact with a shingles rash, for instance if they are covering the wounds and come into contact with the actual seeping wound, they could potentially catch CHICKENPOX if they had not previously had CHICKENPOX or the CHICKENPOX Vaccination. Shingles, meaning the form of chickenpox that comes back up later in life and causes serious pain, cannot be transmitted from on person to another." [Source: http://www.immunize.org/askexperts/experts_zos.asp] Her response was a steadfast, "Well, my doctor doesn't agree. He says you can get it from anyone that has shingles on their skin or has ever had it."

At this point, I once again took the position of not giving a fuck. Either listen to reason or go away. I told her, "If your doctor is telling you this, and he is serious, I think you need to get a new doctor. As I can print out several different papers and references in just a few minutes that would disprove that notion."

Her response was, nothing less than I expected, "Maybe I should get a new pharmacist..." I just sad, in a trailing voice but loud enough for her to full figure out what I PROBABLY said, "I think you should do that you stupid fat bitch..."     Believe me...she was being a standoffish, stupid, fat bitch.

3. Had a lady come to pick up a refill for, of course, Xanax. It was later in the night -- slowed down immensely. I was completely caught up and actually listening to the radio a bit. She came to the pickup window, I looked up her name and immediately saw that we had requested refills, and we had not heard back. She looks me right in the eye and says, "Is it in you box? I mean...can you check your box?...Is it in your box?"    I really wanted to say, "Why no, have you checked YOUR BOX? I'm sure we could hide a set of car keys in there!"  Instead, she goes into a long diatribe about how a 3 months ago she came to pick up her refill and we told her it wasn't called it...only to find out that after she drove "all the way to the doctor's office," [a gas-chugging 4-5 minutes away] "it was sitting on the counter as there was a problem with it." [The doctor faxed it back sans signature] So, I stand by the statement that the doctor hadn't really done his job! At that juncture, we had faxed them back for ANOTHER Auth. Today, I told her that our inBOX didn't receive prescriptions (just email). She asked me to check our voicemail BOX, and I told her I didn't need to as our number of VMs is displayed on screen [I had ZERO]. No other BOXes to check...cept yours, biggun'!

-=+=-

"REFILL TOO SOON," GUYS. That means, in pharmacy lingo, your insurance will not pay for your prescription until the resubmit date. One late night at the pharmacy, which by the way is in the ghetto, a woman comes in to refill her son’s prescription. As I processed the prescription I explained to her that it is a REFILL TOO SOON and the insurance wouldn’t pay for the refill until tomorrow morning. She obviously wouldn’t accept that answer and went into a rant against me (a technician), the pharmacist working with me, and our drug store. As I recall it went something like this:

“My baby needs his medication! He is sick! He needs it NOW!!!!! You stupid white bitch you had better fill my prescription or im going to kick your ass! Her's too. That other bitch pharmacist! What you think yous better than me? I want it now! Ima get me suma that shit now and my momma gon' pay for it! Make it now! Get it ready, Bitch!”

I looked at her, looked at the pharmacist, and explained to the woman that if she would WAIT ONE MORE DAY [less than 18 hours, actually], the prescription wouldn’t have copay because this woman was on state assisted insurance.

I told her that the medication would be $45 and if she wanted it, she could pay for it, but that amount wouldn’t be refunded the next day. Her response, although not responsive to the information, went something like this:

“What you think I’m broke, bitch? I can’t pay for my babay's medicine? Fuck you ima just buy it ima just buy it you can’t tell me what to do, this my babay, THIS MY BABY AND HE NEEDS HIS MEDICINE NOW GET IT READY DUMB BITCH.”

You're not broke? Oh, okay. Then I guess you’re just one of those lazy folks who doesn’t work and just expects the government to pay for your prescriptions. I can safely assume you are probably on food stamps too? Welfare? You're yelling at me, and I am partially paying for your prescription by paying taxes? I have no choice but to have my tax dollars used to pay for “your babay's medicine,” and I have no choice but to abide by your every wish and want because 'the customer is always right,' right? So, I swallowed my insults, and I bottled my anger, and filled the prescription.

By this time, her mom (the "babay's" grandma) came to the counter and apologized profusely with the accurate explanation that woman was mentally retarded. MENTALLY RETARDED. And she has children? What the fuck. You can draw your own conclusions on that one. And by the way, after all that, she didn’t, or better yet, her mom didn’t buy the medication because she, having some sense about her, WANTED TO WAIT UNTIL THE NEXT DAY. By the way, the drug was for SEASONAL ALLERGIES. Not seizures, not juvenile diabetes, not horrible psoriasis, not dangerous asthma, not epi or glucagon. SEASONAL ALLERGIES. Couldn't wait 18 hours, and *I'm* the dumb bitch.

-=+=-

Do you want to submit a guest post [since I don't post nearly enough]? Type it up and email it to me via the same contact page. Also, let me know if you want your name/email address shared publicly, what POLL question you would like to accompany it (if any), and anything else you think is important. Guest Posts will be edited for grammar and spelling. I may also add emphasis, clarification, funny links, or other silly stuff [I might remove inappropriate stuff as well]. I will NOT alter the content/message of your post.

I get talked to like I'm a piece of shit all day. I'll be damned if I'm gonna come home and take e-shit from some nameless fuck over the internet (I do realize the hypocrisy of using the term 'nameless fuck' as I am one). But, what I mean is, people stumble upon this site and give me shit -- non-pharmacists, non-healthcare workers, nobodys.  I'm not that bad. I'm not a horrible person. Some of this is a joke. It's an act. It's a persona in some ways.

I do (or envision and reimagine) the things that you want to do but can't. A favorite comment from these nameless fucks is that I would/should be fired in their business for doing X or saying Y. Who are they to judge me or question what I do.

I can't fully express how much this pisses me off. Nor can I adequately express how some of these hatred and anger is misplaced. I'm not a bad guy. I'm not an unethical dick. 'You' just don't like THAT post.

Now, don't get me wrong -- I'm not deleting these comments because they person questions my judgment or doesn't like what I did. I can handle a dissenting opinion. That's not the issue. I would be FINE with that. But, I've yet to have a dissenting opinion posed in a professional manner worthy of being posts. For instance, in response to, "Unfortunately, this is  a true story" I got the following comment:

"This was written in a humorous way I’ll give you that.. Guy sure was stupid LOL!! I would fire you ASAP but I suspect you probably own or manage the pharmacy in the story, which is even more repulsive. You sir sicken me, and should be ashamed of your profession."

Now, do you see how that has no point? That serves no purpose other than to push me down (as well as the profession of pharmacy. Now, I can accept that this situation could have been handled a different way. But, unless you present a clear and concise rebuttal without resorting to belittling me or our pharmacy, I don't give a fuck what you have to say. Now, you don't have to be a kissass, but you can bring about a different POV without being a prick. Here's what you could say:

"While I agree that was frustrating, you handled it dead wrong. You're a pharmacist and obviously have some education. Not everyone in the world is a smart as you. Some people need things spelled out to them. Some people have learning disabilities. Did you ever things of that? Did you do what they taught you in school and ask him to show you how he will use the inhaler after you educated him? Oh, I forgot, you barely did educate him. This situation is nothing but a failure of a pharmacist to counsel a patient effectively.

See how that works? With a little cunning, you can tell me I'm wrong, pose your opinion, maybe even take a jab at me, have your comment posted, and not get permanently banned from my site WITHOUT BEING A SNIVELING PRICK. I'm not saying you can't swear. I'm not saying you can't question me or what I did. Just don't be a jerk. Don't attack me -- unless it is REALLY fucking funny and REALLY fucking good.

So, how do I remedy this? I thought about deleting all comments and blocking all future comments/discussion, but I value that input from fellow pharmacists and technicians. Instead, I've decided to require registration. That means that initial registration will require a name, verified email address, and maybe some other information as I see fit (such as an acceptance of terms of service). Then you can post comments on the site. After a certain number of approved comments, you will get the ability to post comments that skip my moderation -- after earning trust so to speak.

http://www.theangriestpharmacist.com/wp-login.php?action=register

We'll see how this goes for a while. Maybe a little bothersome registration will prevent assholes from doing what they do best.

Now, this young lady didn't say that -- it was a variant that can be equally suspicious, "How much does this cost? Cash Price. I no longer have insurance." The fact someone says this isn't always suspicious, but the fact she said it twice (and awkwardly at that) did set off my bullshit detector. She told me that she wasn't on file -- luckily she was -- and lookie there....A MEDICAID CARD! I, of course, didn't tell her that I had this information.

I ran it, and low and behold, it rejects. I call up Medicaid to inquire about doses, quantities and where. They tell me a Norco 7.5/325 #90 (30 day supply) filled at a nearby CVS about 14 days ago. [The Medicaid agent gave me the Fraud Line and urged me to call. She also said that the new Rx could be filled in NINE DAYS based on carryover days, etc.] The Vicodin prescription was written 4 days ago. I called CVS, verified Name, birthday, medicaid ID number, and made sure it was picked up. Now, we have a problem.

I wrote her Medicaid ID number right next to her name (very big). I also wrote a note explaining the entire situation on the face of the full page prescription. When she came back to pick up the prescription, we had the following exchange:

[The most unfortunate thing here is that while the following is occurring, there is a 4 or 5 year old little girl stumbling around in front of the pharmacy munching on a cherry Dum-Dum I had given her...unable to comprehend the gravity of what was going on in front of her...the mistakes her mother was making before her eyes.]

"We have a bit of a problem here. We had you on file, and we happen to have your Medicaid Card and ID number on file. As we ran this it came back that it was a refill too soon and duplicate therapy."
"I don't have any insurance or medicaid. I didn't fill anything at CVS..."
"Stop lying to me. I called Medicaid and they told me that #90 Norco 7.5/325 tablets were filled at CVS 14 days ago. I called CVS and verified this information. They also checked the signature logs and found your name signed to the electronic pad. Now, if you genuinely have no idea how this prescription got filled or what is going on here, I can pursue this matter further. However, if you are lying to me, of which I have ZERO reason to believe you are telling the truth, this will end very badly for you."
"No Sir. That won't be necessary."
"I was told by Medicaid that you can fill that in 9 days. I wrote that date on the prescription along with a little note in case you decided to try and take it anywhere else. I've also notified the area hospitals, clinics, and pharmacies through our area 'doctor shopping fax tree.' I also have no choice but to call the Medicaid Fraud Line and notify them of this. I hope these measures prevent you from making any more attempts to acquire controlled medications. Up to this point, you haven't been caught. In the future, you will get caught, and what you are doing is a felony, and it's fraud. Now, for your young daughter's sake, I would hope you turn over a new leaf."
"I will. I promise. You don't have to worry about me ever again. You don't have to call anyone about me. I'm sorry. Thank you. Have a nice day...." [And she scampered off as quickly as possible with her daughter in tow.]

For what it's worth, I did not call any hospitals, doctors, or clinics, and we don't have a "doctor shopping fax tree" (but now that I invented the idea of it, it sounds like a great idea!). I also have no yet called the Medicaid Fraud Line because I was on hold for more than an hour (I left it on speaker), so I gave up and hung up. I said all that stuff in an attempt to scare a 23 year old girl back onto the straight and narrow path. Maybe it was too harsh. Maybe I was wrong in doing all of that. What do YOU think?

A few days ago was Halloween. Another right of passage for the American childhood. The under thirteen crowd walk around with Mom and Dad to all the neighbor's houses for goodies and sweet to rot away their teeth. The over thirteen to eighteen crowd is, of course, too cool and too old to trick or treat, but they want to enjoy the atmosphere. They want to be out and about on Ghoul's Night. They do what we all did -- toilet paper and/or egg friend's houses.

This time, however, one of these little bastards went too far. I was on my way home from work. It was about 4pm on Monday 11/1/2010 (A binary day!). Cold but still a bit a daylight left. I was making my way through my little town's Memorial Park -- all towns have them these days. A quaint little square for public use. There may be a little bit of playground equipment. Trees. A sidewalk path next to a dirty pond, perhaps. But, the hallmark of the Memorial Park is the source of it's name -- the memorial. This is usually in the form of a retired fighter jet, a huge tank, or in my town's case, both. I live in a small town -- actually, I live miles outside of it. It's like Mayberry. The population is about 5-600. There's not a lot of business -- just a gas station where the old men hang out and drink coffee from 4am until they hit the fields, a hair stylist place, a daycare, and a mechanic. The closest big town (population of 13-14,000) is 15 minutes away. That's the nearest grocery store / Wal-Mart.

So, you get the picture. It's a town full of pride. Everybody knows everybody. Everyone would give their neighbor the shirt off their back. I'm new to the town as we moved here about 5-6 months ago. I'm probably still known as the "snotty pharmacist" as I haven't gone out and made a huge effort to inculcate and meet lots of people. They have a Mason temple -- maybe I'll join that and meet some friends.

Anyway, as I drove through the Memorial Park that day, I saw that the entire park had been "rolled," if you will. It was hanging from all the trees. There must have been a hundred rolls used. The town only has one cop and the sidewalks roll up after 9pm, so if these punkass kids did this after midnight, there's a good chance that no one knew/saw except them and God himself. Now, what burned my ass up was the face that they covered the park's tank in toilet paper. Secondary to that -- why was this not cleaned up by the townspeople sooner as it's now 4pm. I screeched to a stop and parked next to the tank -- I snapped a picture with my cell phone planning on sending it to the newspaper with some commentary. Parents should be ashamed if their children were responsible for this. Perhaps a rant on patriotism. And definitely a photo of the tank cleared of all disrespect (while adjacent trees still bear the evidence) -- showing that I still have a shred of passion for this country and respect for the icons that made it what it is.

As I climbed on top of the tank, I wondered how could kids do this? I only have a dog, but she knows better. I guess the fact that these kids have the privilege to walk down the street at midnight on October 31st was lost upon them as they desicrated one of our relics.

Honestly, I think I blame everyone else more than the children. I blame their parents for not showing them proper respect for our country -- probably by talking on their cell phone during the national anthem or taking their own freedoms for granted. I think I blame our school system by not instilling that fire in them. Sure, they may say the Pledge of Allegiance every morning, but did we teach them what the words mean? You can read Shakespeare all day but if you don't learn what the words mean, it's useless.

So, parents out there. Instead of raising little bastards like the people in this town. Please teach your children to be respectful off all that we enjoy.

We all know they suck...but do you know why?

Is it because they are pushing all this clinical pharmacy/residency bullshit down the throat of our schools and therefore our students? Well, yeah.

Is it because they promise to lobby for pharmacy but refuse to accept that retail pharmacy is the backbone of our pharmaceutical (and entire healthcare) system? Well, yeah.

Is it because they have yet to use the power of the pharmacists they represent to achieve the goals they haven't yet set for themselves (because they failed to see the necessity)? Well, yeah!

Is it because they have taken the money of pharmacists across the nation (in the form of dues) and rather than benefit the profession, adequately lobby Congress for ANY change, or fight for pharmacists working 12+ hour shifts without a break (all the while attempting to ignore it's even pharmaceutical care in the first place) they have let the PROFESSION OF PHARMACY become a demeaning JOB? -- Where the community expects it in 5 minutes, for $4 (or free), and to be given a $15 gift card for their trouble? WELL, YEAH!

Is it because they thought it appropriate to waste time and money on THIS STUPID BULLSHIT? Oh, you'd better fucking believe it.

APhA - you had your chance. For fuck's sake, you've been at it since 1852. Now, I will admit, pharmacy has changed for the better. You might have played some role in the changes over the past 20 or so years -- you sure as shit will claim them as your victories. But, for right now, you aren't doing anything.

You've become worthless.

You've allowed yourself to be so focused on expanding on facet of pharmacy, clinical pharmacy (to you "better pharmacy"), you've completely forgotten to take care of the boys in the trenches -- retail pharmacy -- WHERE YOU FUCKING STARTED AT!

Well, now you've been weighed, you've been measured, and you have been found wanting.

There's somebody new in town. The Pharmacy Alliance knows what we want. It also knows how to get there -- utilizing the power of each individual as the source of strength for the whole. You may be the big dog right now, but guess which type of pharmacists make the most money? That's right -- the ones that you have scorned, ignored, and left for dead.

I gave you a little coin in the past. I regret that now -- seeing that you used it to make stupid ass videos and pander to your special BCPS buddies. Instead of give that little to you, I'm giving a lot to TPA (once they get that whole 501c3 thing sorted out of course...:-)

Sincerely,
TheAngriestPharmacist

PS - I realize the irony that I was moonlighting as a clinical pharmacist. My buddy's vacation is over, he's back from Midyear, and that has come to an end. They offered me the job, and I didn't take it. I'm a Retail Pharmacist, bitches.

PPS - I'd like to thank Tom, loyal reader and pharmacy student extraordinaire, for pointing this ATROCITY out to me.

Well, Imitrex is going off patent, and Dr. Reddy's is itching to get into that generic migraine therapy market that is currently absolutely DOMINATED by ridiculously expensive name brand medications. As you can see above, these fucking things are $27 PER TABLET. As you might have expected, now that Imitrex is going to have an AB-rated generic equivalent, it is complete junk and no longer efficacious for migraine headaches (with or without aura).

So, what comes to mind when you see what GlaxoSmithKline is doing here? To me, I think of the assraping of American citizens that are already struggling to make ends meet in a time of economic hardship. I think of GSK playing tricks on Americans that may not have as much education as their local pharmacist. I see that GSK knows that people who are suffering from migraines will pay anything to no longer be suffering from migraines. They are banking on that fact. Now, they are hoping that maybe just once, Imitrex didn't provide you full relief -- just enough of a chance to get you to call up your doctor and ask for a prescription for that new drug, Treximet, that you just saw on television. [I've seen Treximet ads on 5 different channels today.]

Ya know, I wouldn't be surprised in the fucking LEAST if GSK hasn't been slowly dropping the potency of Imitrex tablets over the last few months -- in hopes that their migraines won't clear up and they'll seek out a new therapy.

But TAestP, WHAT IF TREXIMET REALLY IS BETTER????

I don't doubt the efficacy of Treximet. But, I have a few insights here. Does Naproxen alleviate your migraine symptoms? I'm sure you tried it initially as it's in every major migraine algorithm after Acetaminophen and Ibuprofen. If you're taking Imitrex, that probably means you failed Naproxen therapy. So, why are we adding it back on board now?

Does anyone know how much Sumatriptan tablets are going to cost? It doesn't really matter exactly how much they are going to cost -- we know that the generic is going to be cheaper. We also know that NAPROXEN IS DIRT FUCKING CHEAP. So, once again, big pharma has taken two seemingly inexpensive drugs, combined them, called them gold, and made them just as expensive.

Here's a few notes I'd like to share:
- Clinical Pharmacology lists "Krymchantowski AV. Naproxen sodium decreases migraine recurrence when administered with sumatriptan. Arq Neuropsiquiatr 2000;58:428—30." as a source for why the combination is better. What's wrong with this study? Well, how about the fact it was tested in 67 (56 women) people by ONE researched in RIO DE JANEIRO. It's way too brief. The methods are weak. It is a poorly done study.

- Also listed as a reference is: "Brandes JL, Kudrow D, Stark SR, et al. Sumatriptan-naproxen for the acute treatment of migraine: a randomized trial. JAMA 2007;297:1443—54." -- This one is cited because it shows that 'more patients had sustained pain free responses 2-24hrs after the dose with decreased recurrance rate in combo vs either drug as monotherapy or placebo. I didn't even read this study -- I flipped to the back page, as I always do, and saw all that I needed to see.

Funding/Support: The 2 clinical trials (MT-400:301 and MT-400:302) described in this article were funded by GlaxoSmithKline in partnership with POZEN, the IND sponsor of the investigational drug MT-400 (sumatriptan–naproxen sodium).

Role of the Sponsors: GlaxoSmithKline and Pozen Inc provided financial and material support, monitoring, data collection and management, and data analysis to the authors and study investigators.

In case you were wondering, POZEN INC is a puppet company of GlaxoSmithKline. And, as you can see, they performed the ENTIRE FUCKING STUDY.

Also of note regarding this filth of a study fabricated to bilk money from the American people, of the 10 'researchers,' two admitted to working for 'Pozen' and two for GSK --- all of which work in Chapel Hill, NC.

-The final study listed in ClinPharm boasting this drug is merely a safety and tolerability study. Well, fucking duh this drug is tolerable. How often do you think people need to take Sumatriptan? Once every other day? Once a week? Heck, the max daily dose is 2 tablets. So, the most Naproxen you could get is 1000mg -- a normal daily dose -- which wouldn't be ingested that often. Of course it's safe.

Of course it's non-inferior. Of course it's safe. But, is it cost effective? No. It's not. Because you motherfuckers at GSK have no fucking morals. You're soul-less pieces of deep fried pig shit, and I hope all of you get the pleasure of having Alzheimer's as you age. You all deserve to be beheaded on Al-Jazeera. You're nothing. You're wastes. I wouldn't shit on you if I got paid a million dollars to fill "2Guys1Face." I hate you more than I hate everything else combined. I just wish that there was some way I could just remove the money from you via osmosis and have you thank me for it -- much like the unsuspecting public is doing now.

You may give them a $20 coupon or even a few free pills, but I'm hip to your game GSK. I'm not gonna play. My pharmacy will NOT carry your product. My pharmacy will NOT dispense your product. If someone brings me a script for this bullshit, I'm going to be having a conversation with a doctor. I'll end up filling two prescriptions and having a little education session. I just pray that you don't send some fucking big-tittied Treximet Drug Rep to me. That bitch will leave in tears...

In chemistry, many compounds are composed of isomers. Isomers have the same molecular formula but are structurally different. Basically, they are shaped a little different. Sometimes, the isomers have the same results in the body. Other times, the isomers of a compound have different effects altogether. Still yet, some isomers cause side effects and the other isomer gives us the intended result (or one isomer is active and the other is completely inert). All compounds are either levorotatory or dextrorotatory (Called l-DRUG or d-DRUG *or*  (-)-DRUG and (+)-DRUG, respectively). Levo compounds rotate polarized light (in a polarimeter) counterclockwise and dextro compounds rotate the same light clockwise.

I'm not going to get into the difference between constitutional and spatial isomers, cis/trans isomers, or R and S notation. Mostly because I will get out of my realm of knowledge quite quickly.

Most drugs out on the market are racemic mixtures. This means that they are combinations of d- and l- isomer. Most drug companies have fucked the common man by doing some shady shit (thereby pulling the wool over everyone's eyes).

Citalopram (Celexa) is a racemic mixture. Only the Dextro isomer is active. It was a heavily used drug indicated for major depression, social anxiety disorder, and panic disorder. Forest spent millions ensuring that every doctor had a big breasted woman peddling the drug to them praising it. It *was* the best available. Until the patent ran out. Then, it was no longer good enough. Now, the inactive isomer has been removed. Escitalopram (Lexapro) is now the best drug available if you ask the crooks at Forest. It is also indicated for depression, social anxiety disorder, and panic disorder.

Here's some more (all with the exact same story -- new drug is "better"):
Venlafaxine (Effexor)  ====>  Desvenlafaxine (Pristiq) -- Wyeth
Loratadine (Claritin) ====> Desloratadine (Clarinex) -- Schering
Cetirizine (Zyrtec) ====> Levocetirizine (Xyzal) -- Pfizer for Zyrtec/Sanofi for Xyzal
Omeprazole (Prilosec) ====> Esomeprazole (Nexium) -- Astrazeneca
Methylphenidate (Ritalin, et al) ====> Dexmethylphenidate (Focalin) -- Novartis
Dexchlorpheniramine, Dexbrompheniramine =
Chlorpheniramine, Brompheniramine -- Various Manufacturers
Albuterol (Proair, Ventolin, Proventil) = Levalbuterol (Xopenex) -- Various/Sepracor
Imipramine (Tofranil) = Desipramine (Norpramin) -- Different Manufacturers
Nortriptyline (Pamelor) = Protriptyline (Vivactil) -- Different Manufacturers

In every case where the same company is involved in the new drug, no improvements were made. Of course, the manufacturers would lead the unwitting MDs to believe that side effects were cut down, efficacy was increased, and the old drug causes users to grow an extra appendage on their neck. So, "everyone needs to be switch NOW! In fact, here's a stack of preprinted prescriptions for you to sign and hand out to your patients."

I say fuck that. No one ever asks me about these new drugs, well, now I'm saying it. All this shit does is cause more work for me. How, you ask? Has anyone out there ever gotten a Xyzal to go through? Hell no you haven't. Why not? It's too fucking expensive because the same drug is now available OVER THE COUNTER. So, I have to call the MD and have them get a PA. Then, some nurse wastes time calling the insurance company. Then, the patient has to pay a $45 copayment for a drug available on aisle 9 for $5.99/15 tablets. These drug companies are out of control -- as profit margin continues to shrink and edge closer and closer to 2%, these fucking guys are finding new ways to nickle and dime us indirectly. The time wasted, along with the crap repayment from this drug of equal efficacy, is merely another way to bone us.

Make a stand with me. You get a script called in or brought in for these damn drugs, call the doctor. Get it changed. They don't answer or you leave a message, change it anyway. Make it a "fill--call." If they say no, call the doctor a stupid motherfucker then overlook it. He'll never notice or know.

He's too busy with his head buried in some drug rep's tits pushing the new DRUG OF CHOICE FOR GENERALIZED ANXIETY DISORDER -- levoparoxetine or desmethylfluoxetine or some other bullshit.

That's right. They call me at my job, who currently pays my bills, and asks me if I want to quit and work for any company that will take me. They will promise you the world. Can they deliver? They don't know. They don't care. They likely read off a script just like every other telemarketer in America.

I understand as well as anybody that it takes a ton of different people to make the world go around. For every job, there is a worker willing to take that job at that wage. It may not be what I would want to do, or what I could earn, but the job is there nonetheless.

But, how in the fuck do these people make their place in the world? I just don't get it! I could not imagine a pharmacist, regardless of their level of disgruntlement, saying, "Yeah, I'll quit this bitch for whatever job you can find me with XYZ company." I've never heard of someone doing it. So, I've never heard of a success story. To make matters worse, they bother us at our already hectic jobs. This pisses us off and REALLY makes me want to jump ship!

What makes this specific commenter all the more asinine is that I had a run in with her a while back. The Pharmacy Alliance had an oft-used email listserv prior to their meeting in Texas. She chimed in with this same recruitment chum. I didn't reply in a swear laden hate-speech. I didn't even tell her to go fuck herself. I just replied with, "Whoa."

Now, at work, I like to fuck with these people. The way I see it is that my time is money. I'm sure my time is worth more than there's, but I'm a huge dick and I like to get a laugh at other people's expense. I often ask them for all the details and not pay a lick of attention. Then I ask them again. After that I'll ask them random questions they have no business knowing until they get the hint. "Ma'am, why can't tigecycline be used for bactermia?" or "Why is Zyvox contraindicated in people on MAOIs?" or "What's the max daily dose of Oxycodone in a properly titrated person" or my personal favorite, "Why can't enteric coated aspirin be used to treat a headache?" If they still don't get the hint, I ask them, "Why does Mickey Mouse have big ears?" -- That's usually the fuck off question that gets em.

Bonus points for answering the real questions in the comments.

A new submission (form: "Contact Form")
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Submitted on: June 4, 2008
Via: http://www.theangriestpharmacist.com/contact/
By <edited out IP> (visitor IP).