Saturday, June 15, 2013
Wednesday, June 5, 2013
The Cynical Pharmacist Stats
I've been writing The Cynical Pharmacist for over two years now and it seems as though I've picked up a few loyal readers along the way. Mind you, I'm not out to keep track of who's visiting this blog, and truthfully, I really don't care. I author this blog for my own personal satisfaction. The way I see it, if you want to read what I have to say, that's great. If you don't, that's cool too.
But, the fascinating part to me of authoring this blog over the past two years is that what I think are the best posts and what my readers think are the best posts are vastly different. So, I thought I would share the top-ten most read posts according to the highest page views as of today. Drum roll please.
1. KeySource Medical Wholesale License Suspended. #1 by a wide margin. Who would've thunk?
2. The Real Drug Nazi. I thought this post would be #1.
3. How To Handle A Difficult Customer. Okay, kinda funny, but #3?
4. Which Car Do Pharmacists Drive To Work? Really? I never would have figured.
5. The Lonely Life Of A Cynical Pharmacist. WTF? Revealing, but who's interested?
6. Young Pharmacists Rule. Okay, kinda cool and entertaining, but #6?.
7. Carisoprodol Changes To Schedule IV. Really? Nothing you couldn't have learned elsewhere.
8. All Superheroes Must Die. Funny, but kinda important.
9. Who's Really Exploiting The System. Serious and factual, but #9?
10. So You Want To be A Floater, Huh? Okay, somewhat truthful in a humorous AZ way.
But, the fascinating part to me of authoring this blog over the past two years is that what I think are the best posts and what my readers think are the best posts are vastly different. So, I thought I would share the top-ten most read posts according to the highest page views as of today. Drum roll please.
1. KeySource Medical Wholesale License Suspended. #1 by a wide margin. Who would've thunk?
2. The Real Drug Nazi. I thought this post would be #1.
3. How To Handle A Difficult Customer. Okay, kinda funny, but #3?
4. Which Car Do Pharmacists Drive To Work? Really? I never would have figured.
5. The Lonely Life Of A Cynical Pharmacist. WTF? Revealing, but who's interested?
6. Young Pharmacists Rule. Okay, kinda cool and entertaining, but #6?.
7. Carisoprodol Changes To Schedule IV. Really? Nothing you couldn't have learned elsewhere.
8. All Superheroes Must Die. Funny, but kinda important.
9. Who's Really Exploiting The System. Serious and factual, but #9?
10. So You Want To be A Floater, Huh? Okay, somewhat truthful in a humorous AZ way.
Monday, June 3, 2013
Smoking Alcohol
I'm always fascinated with the crazy new ways younger people keep coming up with to abuse drugs. Today I ran across an article describing a new technique for abusing alcohol.. smoking alcohol.
According to the abusers, when liquor is poured over dry ice, the vapor produced from that reaction is said to contain alcohol. So, instead of drinking the liquor in order to catch a buzz, the vapor is inhaled instead. It's being said that it's gives a "smoker" a quicker buzz because it is directly absorbed into the bloodstream through the lungs, bypassing oral absorption and the first-pass effect.
And because the vapor is inhaled, and the liquor is not drunk, it's also been said that it's a calorie-free way to get drunk. One can supposedly abuse alcohol without weight gain. Here's a video report of it -
Notice that I said "supposedly" because I'm not sure that I buy into this purported chemical reaction. I don't see how anyone could "smoke" alcohol this way. Let me explain my reasoning, and please feel free to correct me if I'm missing something. And no, I'm not drinking while I type this.
The alcohol contained in liquor, ethanol, is hygroscopic and very miscible with water. While hydrated ethanol (<200 proof liquor) may be somewhat volatile over time depending upon temperature, getting it to break it's bond with water quickly and to vaporize requires the addition of heat and flame.
You see chef's use this technique (flambé) all of the time when they cook and flavor their dishes with certain liquors. They add the liquor to the dish during cooking to "burn off" most the ethanol content, while leaving the liquor flavor in the pan.
Dry ice is frozen CO2 (carbon dioxide). It is MUCH colder than the usual "water" ice. When water, ethanol, or liquor is added to dry ice, the dry ice "sublimates" (changes directly from a solid into a gas) much quicker, producing that cool cloud of smoke everyone is familiar with (vapor).
Now, here's where I don't understand the supposed chemical reaction. The way I see it, there is no "liquid" dry ice for the ethanol to mix with and be released. And the dry ice is so cold that it would also seem to reduce the ethanol's volatility, thereby keeping it hydrated instead of releasing it into a vapor. Then how does the alcohol vaporize? I don't think it does. I think it remains in solution.
So, while it may "look" like someone is "smoking" alcohol because of the sublimation of the dry ice, what they're really doing is just inhaling the carbon dioxide vapor. I'd bet there isn't any alcohol at all (or very minimally) contained in that vapor.
Personally, I would be very skeptical about "smoking" alcohol as being an effective or dangerous way to abuse alcohol. However, I do see it as a dangerous way to abuse carbon dioxide. Inhaling carbon dioxide is not safe, and can lead to hypercapnia. So, it should be avoided simply for that reason.
According to the abusers, when liquor is poured over dry ice, the vapor produced from that reaction is said to contain alcohol. So, instead of drinking the liquor in order to catch a buzz, the vapor is inhaled instead. It's being said that it's gives a "smoker" a quicker buzz because it is directly absorbed into the bloodstream through the lungs, bypassing oral absorption and the first-pass effect.
And because the vapor is inhaled, and the liquor is not drunk, it's also been said that it's a calorie-free way to get drunk. One can supposedly abuse alcohol without weight gain. Here's a video report of it -
Notice that I said "supposedly" because I'm not sure that I buy into this purported chemical reaction. I don't see how anyone could "smoke" alcohol this way. Let me explain my reasoning, and please feel free to correct me if I'm missing something. And no, I'm not drinking while I type this.
The alcohol contained in liquor, ethanol, is hygroscopic and very miscible with water. While hydrated ethanol (<200 proof liquor) may be somewhat volatile over time depending upon temperature, getting it to break it's bond with water quickly and to vaporize requires the addition of heat and flame.
You see chef's use this technique (flambé) all of the time when they cook and flavor their dishes with certain liquors. They add the liquor to the dish during cooking to "burn off" most the ethanol content, while leaving the liquor flavor in the pan.
Dry ice is frozen CO2 (carbon dioxide). It is MUCH colder than the usual "water" ice. When water, ethanol, or liquor is added to dry ice, the dry ice "sublimates" (changes directly from a solid into a gas) much quicker, producing that cool cloud of smoke everyone is familiar with (vapor).
Now, here's where I don't understand the supposed chemical reaction. The way I see it, there is no "liquid" dry ice for the ethanol to mix with and be released. And the dry ice is so cold that it would also seem to reduce the ethanol's volatility, thereby keeping it hydrated instead of releasing it into a vapor. Then how does the alcohol vaporize? I don't think it does. I think it remains in solution.
So, while it may "look" like someone is "smoking" alcohol because of the sublimation of the dry ice, what they're really doing is just inhaling the carbon dioxide vapor. I'd bet there isn't any alcohol at all (or very minimally) contained in that vapor.
Personally, I would be very skeptical about "smoking" alcohol as being an effective or dangerous way to abuse alcohol. However, I do see it as a dangerous way to abuse carbon dioxide. Inhaling carbon dioxide is not safe, and can lead to hypercapnia. So, it should be avoided simply for that reason.
Saturday, June 1, 2013
Magnesium | A Short Film
Everything worth doing in life requires constant focus and attention in order to succeed.
By being well-prepared beforehand, much of the heartache and regret that comes with experiencing the difficulties of poor choices or failures in life can be better managed, or avoided altogether.
The same applies to having unprotected sex.
If you're going to choose to have sex, then be well-prepared to do it safely - beforehand.
Otherwise, just like efforts to become a top gymnast, one slip up and you'll fall flat on your face.
MAGNESIUM from Sam de Jong on Vimeo.
By being well-prepared beforehand, much of the heartache and regret that comes with experiencing the difficulties of poor choices or failures in life can be better managed, or avoided altogether.
The same applies to having unprotected sex.
If you're going to choose to have sex, then be well-prepared to do it safely - beforehand.
Otherwise, just like efforts to become a top gymnast, one slip up and you'll fall flat on your face.
MAGNESIUM from Sam de Jong on Vimeo.
Monday, May 27, 2013
Pharmacy Compounding And The Public
There's a very good reason why early 20th century laws, like the Pure Food and Drug Act, the Federal Food, Drug, and Cosmetic Act, and other FDA legislation were enacted.. because many innocent Americans died or suffered as a result of the unbridled quest of a few for greater profits.
When harmful consequences caused by those few begin to affect a significant portion the American public, our Federal political leaders need to act quickly and succinctly in order to protect the public and ensure that it doesn't happen again. IMO, that's not what's happening in pharmacy compounding.
For those unfamiliar with pharmacy compounding, let me explain how the process has worked over the years to give you a better understanding of the problem -
Traditionally, when a physician wants to provide a remedy for one of his/her patients, but such a remedy isn't commercially available (made by a pharmaceutical manufacturer), that physician would write a prescription for that patient, to be compounded (manufactured) by a neighborhood pharmacist.
This type of local manufacturing complies with the FDA rules and regulations for drug compounding because a physician writes a single prescription for a single individual patient, and because there is a direct relationship between the patient, the physician, and the pharmacist.
All three members of this relationship are directly involved in that one patient's care and can monitor whether that compounded prescription is effective or not. If an error was to occur anywhere in the process, only one patient would be harmed, and the source of that error could be easily traced and quickly corrected. This type of relationship has been working fine for decades.
But then, something changed along the way.
Recent medical technological advances made it possible for pharmacists to compound prescriptions in a more sterile environment. A niche was born, and some pharmacists sought to capitalize on it. Compounding pharmacists began to compound injectable prescription products outside of the hospital environment, similar to pharmaceutical manufacturers.
Over time, those pharmacists discovered that there weren't clear and concise laws regarding the compounding and sales of their products. There was an uncertain quasi-regulation of compounding pharmacies between both the State governments and the Federal government.
Somehow, compounding pharmacies were allowed to skirt the traditional rules of compounding and began compounding products without having that direct patient/physician/pharmacist relationship.
They began compounding injectable drugs without a written prescription from a physician, nor just for single individual patients. That niche progressed to the point where pharmacists started compounding injectable drugs in bulk, for local sale to hospitals, clinics, and doctors offices.
The compounding process further progressed to the point where pharmacists began shipping their compounded products interstate, throughout the United States. In essence, their pharmacies now became pharmaceutical manufacturing plants. But unfortunately, these pharmacies weren't being held to the same standards to ensure public safety that apply to pharmaceutical manufacturers.
Then, for various reasons, injectable drug shortages began to appear throughout the country. These compounding pharmacies began to grow and expand in providing replacements for those shortages.
But, no regulators seemed to be monitoring their activity. Compounders were left to self-regulate.
Because the important direct relationship between patient, physician, and pharmacist was missing, because no one outside of the profession was ensuring quality, and because these products were being shipped nationwide, it seemed only a matter of time before something tragic would happen.
A simple error could be "compounded" from only one patient being affected, to a large number of patients being affected, and it would become much harder to trace the source.
And that's exactly what happened. The multistate outbreak of fungal meningitis and other infections among patients who received contaminated steroid injections from just one compounding pharmacy has currently led to more than 740 innocent people being injured, with 55 deaths.
It's been over six months when we first learned of this tragedy, and yet compounding pharmacies are still being allowed to manufacture their potentially unsafe products, and are still allowed to continue shipping their products nationwide. No one in charge is seemingly attempting to stop it.
It's not like members of Congress are unaware of the unnecessary risks to the American public from allowing pharmacies to manufacture and sell injectable products without having to conform to the same sterility and manufacturing standards in which pharmaceutical manufacturers must comply.
Advocates in healthcare serving the interests of their patients as a whole have provided a simple solution to the problem. According to the Institute for Safe Medication Practices,
But yet, while there's reportedly a unconcerted effort on behalf of state and professional organizations in reaction to the problem, nothing is being done by Congress to simply correct the underlying cause.
House GOP members say that the laws don't need to be changed, and blame this tragedy on lack of FDA enforcement. They refuse to change the laws to clarify the regulatory gaps or work with Senate Democrats to quickly and succinctly rectify the situation. They're resolved to do nothing.
Meanwhile the Senate, acting like they are on the public's side, has taken the initiative to create a new regulatory class of drug manufacturers, confusingly called “compounding manufacturers,” that would be exempt from federal premarket approval and related labeling requirements, and thereby maintaining the status quo.
So I have to wonder, what the hell is wrong with all of these people? Don't they care?
To me, it seems as though no one in authority - not professional regulators, not State regulators, not Federal regulators, and neither political party wants to stop compounding pharmacies from behaving like pharmaceutical manufacturers, even when public safety is significantly at risk.
And that's the true tragedy behind this unfortunate incident.
When harmful consequences caused by those few begin to affect a significant portion the American public, our Federal political leaders need to act quickly and succinctly in order to protect the public and ensure that it doesn't happen again. IMO, that's not what's happening in pharmacy compounding.
For those unfamiliar with pharmacy compounding, let me explain how the process has worked over the years to give you a better understanding of the problem -
Traditionally, when a physician wants to provide a remedy for one of his/her patients, but such a remedy isn't commercially available (made by a pharmaceutical manufacturer), that physician would write a prescription for that patient, to be compounded (manufactured) by a neighborhood pharmacist.
This type of local manufacturing complies with the FDA rules and regulations for drug compounding because a physician writes a single prescription for a single individual patient, and because there is a direct relationship between the patient, the physician, and the pharmacist.
All three members of this relationship are directly involved in that one patient's care and can monitor whether that compounded prescription is effective or not. If an error was to occur anywhere in the process, only one patient would be harmed, and the source of that error could be easily traced and quickly corrected. This type of relationship has been working fine for decades.
But then, something changed along the way.
Recent medical technological advances made it possible for pharmacists to compound prescriptions in a more sterile environment. A niche was born, and some pharmacists sought to capitalize on it. Compounding pharmacists began to compound injectable prescription products outside of the hospital environment, similar to pharmaceutical manufacturers.
Over time, those pharmacists discovered that there weren't clear and concise laws regarding the compounding and sales of their products. There was an uncertain quasi-regulation of compounding pharmacies between both the State governments and the Federal government.
Somehow, compounding pharmacies were allowed to skirt the traditional rules of compounding and began compounding products without having that direct patient/physician/pharmacist relationship.
They began compounding injectable drugs without a written prescription from a physician, nor just for single individual patients. That niche progressed to the point where pharmacists started compounding injectable drugs in bulk, for local sale to hospitals, clinics, and doctors offices.
The compounding process further progressed to the point where pharmacists began shipping their compounded products interstate, throughout the United States. In essence, their pharmacies now became pharmaceutical manufacturing plants. But unfortunately, these pharmacies weren't being held to the same standards to ensure public safety that apply to pharmaceutical manufacturers.
Then, for various reasons, injectable drug shortages began to appear throughout the country. These compounding pharmacies began to grow and expand in providing replacements for those shortages.
But, no regulators seemed to be monitoring their activity. Compounders were left to self-regulate.
Because the important direct relationship between patient, physician, and pharmacist was missing, because no one outside of the profession was ensuring quality, and because these products were being shipped nationwide, it seemed only a matter of time before something tragic would happen.
A simple error could be "compounded" from only one patient being affected, to a large number of patients being affected, and it would become much harder to trace the source.
And that's exactly what happened. The multistate outbreak of fungal meningitis and other infections among patients who received contaminated steroid injections from just one compounding pharmacy has currently led to more than 740 innocent people being injured, with 55 deaths.
It's been over six months when we first learned of this tragedy, and yet compounding pharmacies are still being allowed to manufacture their potentially unsafe products, and are still allowed to continue shipping their products nationwide. No one in charge is seemingly attempting to stop it.
It's not like members of Congress are unaware of the unnecessary risks to the American public from allowing pharmacies to manufacture and sell injectable products without having to conform to the same sterility and manufacturing standards in which pharmaceutical manufacturers must comply.
Advocates in healthcare serving the interests of their patients as a whole have provided a simple solution to the problem. According to the Institute for Safe Medication Practices,
As we move forward and learn from the most recent outbreak, we call upon Congress to work with key stakeholders to address the need for additional laws on the federal level to fill in regulatory gaps. FDA oversight and regulations must be equal to what is required of pharmaceutical companies when compounding pharmacies dispense in mass quantities without individual patient prescriptions, manufacture sterile products from non-sterile active ingredients, or distribute across state lines.Congress has also been told by the FDA that unclear laws make it difficult for them to enforce safety.
But yet, while there's reportedly a unconcerted effort on behalf of state and professional organizations in reaction to the problem, nothing is being done by Congress to simply correct the underlying cause.
House GOP members say that the laws don't need to be changed, and blame this tragedy on lack of FDA enforcement. They refuse to change the laws to clarify the regulatory gaps or work with Senate Democrats to quickly and succinctly rectify the situation. They're resolved to do nothing.
Meanwhile the Senate, acting like they are on the public's side, has taken the initiative to create a new regulatory class of drug manufacturers, confusingly called “compounding manufacturers,” that would be exempt from federal premarket approval and related labeling requirements, and thereby maintaining the status quo.
So I have to wonder, what the hell is wrong with all of these people? Don't they care?
To me, it seems as though no one in authority - not professional regulators, not State regulators, not Federal regulators, and neither political party wants to stop compounding pharmacies from behaving like pharmaceutical manufacturers, even when public safety is significantly at risk.
And that's the true tragedy behind this unfortunate incident.
Monday, May 20, 2013
Nothing Really Matters To Me
It's too late, my time has come. Nothing really matters to me about pharmacy anymore. So, adios.
But, if there's anything I can share with new pharmacists just beginning their careers, it's DO NOT let your employer pressure you into working faster than you think is safely necessary. Trust me on this.
You won't be able to live with the consequences if you make a mistake and seriously hurt someone.
But, if there's anything I can share with new pharmacists just beginning their careers, it's DO NOT let your employer pressure you into working faster than you think is safely necessary. Trust me on this.
You won't be able to live with the consequences if you make a mistake and seriously hurt someone.
Friday, May 17, 2013
Vinchuca In The House | A Silent Killer
Chagas Disease is endemic throughout much of Mexico, Central America, and South America where an estimated > 8 to 11 million people are infected by the protozoan parasite Trypanosoma cruzi.
Infection occurs through vectorborne transmission via the feces of the triatomine insect (reduviid bug, kissing bug, assassin bug, and vincucha bug), which may be inadvertently inoculated into the skin or the mucosa of the eyes, nose, or mouth when the insect’s bite is scratched and rubbed.
The triatomine bug thrives under poor housing conditions (for example, mud walls, thatched roofs), so in endemic countries, people living in rural areas are at greatest risk for acquiring an infection. In rural Argentina, villagers speak of "muerte subita" or rapid death caused by Chagas.
But one Argentinian physician, Dr. Gustavo Farrugia, and his colleagues are trying to stop it.
Source: Al Jazeera: Witness
Infection occurs through vectorborne transmission via the feces of the triatomine insect (reduviid bug, kissing bug, assassin bug, and vincucha bug), which may be inadvertently inoculated into the skin or the mucosa of the eyes, nose, or mouth when the insect’s bite is scratched and rubbed.
The triatomine bug thrives under poor housing conditions (for example, mud walls, thatched roofs), so in endemic countries, people living in rural areas are at greatest risk for acquiring an infection. In rural Argentina, villagers speak of "muerte subita" or rapid death caused by Chagas.
But one Argentinian physician, Dr. Gustavo Farrugia, and his colleagues are trying to stop it.
Source: Al Jazeera: Witness
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