A pharmacist's look at the supermarket and beyond

Month: July 2014

Fenugreek Rears its Head

Recently, PharmD candidate Hannah Shorb found a product on our shelves called Vitali-T-Aid, labeled as a drug free dietary supplement. This product had some interesting phrasing on the front label: Helps Increase Libido (with an asterisk) with clinically studied Testofen, Supports natural increases of free testosterone in men (asterisk) and Helps boost sex drive & performance (yes, an asterisk). The asterisk, leads you to the usual disclaimer that none of this has been evaluated by the FDA. As a dietary supplement, there is minimal regulatory oversight and the product does not need to adhere to pharmaceutical standards. Also notice that Testofen is “clinically studied” which is essentially a meaningless statement without identifying the study findings.
Let’s break it down shall we?



Nutrition Facts
Serving Size : 2 Capsules
Serving per Container : 30
Amount Per Serving:

Testofen 600 mg
This is Fenugreek! If you have been following the blog, you know this was the main ingredient in Milky!, the lactation support product. Not sure what it is doing in here other than no less than the Natural Medicine Comprehensive Database cites reports of increased testosterone levels if 500mg is taken daily for 8 weeks (and you exercise!). Hannah found, however, data that showed that it decreases plasma androgen and lowers sperm concentration. In animal studies, seminiferous tubules and testicular interstitial tissue were damaged and the weight of the testes was decreased. This phenomenon of shrinking balls is seen with anabolic steroid use. When something that mimics testosterone is added to the body the testicles see no need to produce testosterone so they shut down and shrivel away, turning grapes into raisins. No change in strength or endurance was seen in the studies. Whatever fenugreek does in the male body, the results are a mixed bag, pardon the pun.

Male Wellness Blend 100 mg contains:

Saw Palmetto Berry Powder
Saw Palmetto is a popular prostate supplement and is antiandrogenic, that is, it works against masculine hormones. That is helpful for enlarged prostate and in controlled trials erectile dysfunction, ejaculatory dysfunction and reduced libido were all reported. So what the hell is this doing in this product???

Astragalus Root Powder
This may actually do some good in sufficient doses. It dilates blood vessels, so more blood flow, increases sperm motility, which is good if pregnancy is your target, and is diuretic, which may help if peeing like a racehorse makes you feel more manly. However, the dose is quite small per serving.

Phytosterols may actually reduce production of testosterone and dihydrotestosterone. Again, very counter-productive. Why is it here? 

Asian Ginseng Root Powder –  
There is some evidence of small effects for increased libido. Ginseng is a popular memory supplement and just having a slight boost to your mental acuity could be a turn on.

Tribulus Fruit Extract –  
This is a good source of saponins which may be good for your sperm health according to animal studies, but has no effect on testosterone levels. Again, if making a baby is your goal…

L-Arginine USP
This one is all about blood flow. 4 to 6 grams a day are shown to improve sexual function in men with organic erectile dysfunction when taken for 6 weeks. Since there is only some fraction of 100mg in each dose here, it is unlikely that it will help. Notably, arginine is one of the key ingredients in “Dream Cream” which is sold to “enhance female sexual sensation” and is applied directly to the lady parts. Arginine does lead to higher levels of nitric oxide which is needed to relax smooth muscle in erectile tissue resulting in better blood flow. A guy might be better off to skip this tiny amount in these capsules and just have a dream cream party for two, rubbing the arginine cream all over each other’s erectile parts. I’m excited already!

This stuff goes for about $40 and has many ingredients in conflict with one another. As with most of my recommendations, I prefer to select individual ingredients, not some shotgun formula like this one. Most of the effect would derive from the effectiveness of the advertising on the label. If you believe you are one studly human then you may act like one. I like to think that the brain is the sexiest organ of all. A little whipped cream could be fun too!

Managed Wellness

The first patient of the day asked how long he should keep taking Nexium, which he was buying as an OTC item. I told him that when these drugs first hit the market the labeling was for six weeks of treatment during which a person could start making some dietary changes to keep the stomach acid at a more reasonable level. “Hell,” he said, “I’ve been taking them a long time.” Sadly, this is true of most folks who get started on these proton pump inhibitors. They never want to stop. I told him, “if you’re on a diet of pepperoni pizza and beer then you’ll probably want to stay on it.” He countered that with, “How about fired chicken and beer?” and I put him in check with “That’s not a whole lot better!” He paused a bit, thinking things over and concluded, “Fruits and vegetables, huh?”

This episode, coupled with the Crestor-sponsored dinner I attended last night, started a train of thought that has appeared now and then throughout my career. Crestor is a drug that lowers the “bad” cholesterol, LDL. New guidelines recently were published that suggest that almost everyone over 21 should be taking a drug like Crestor, one of the “statins.”

Our pharmacy see numerous patients with syndrome X, metabolic syndrome, pre-diabetes, and type type-II or adult onset diabetes. Many of these patients are buying drugs to treat what is often a self-inflicted malady, uncontrolled blood sugar. They are usually overweight or obese. Some have high blood pressure.

These three different types of patients are all told the same thing when they see a doctor and are diagnosed. “Your condition can be greatly improved with diet and exercise,” they are told as the doctor is writing a prescription or two. Rarely is there an Rx for a diet and some exercise suggestions. Maybe there are pamphlets in the waiting room. Almost never is the patient given a guideline and the tools to get healthier, beyond “here, take these pills.” Why not take the time to calculate what the daily calorie intake would be to enable the patient to lose, say, a pound every week or two? Give them some tools to get that done. Why not talk about a graduated exercise plan that can actually be accomplished? Once again, give the patient some tools.

There are many reasons that diet and exercise is not successful treatment for many conditions. My train of thought brought me to the conclusion that one of the main factors is that both prescribers and patients have been taught that the “best” way to correct the problem is to “TAKE A PILL!” We have established this odd co-dependency where we take the pills as ordered so that we can continue our slovenly lifestyle and poor (but fun!) dietary choices. It’s as though we just want to stay even, thinking, “I’m OK now, I’ve got a pill to take for my (fill in the blank) so I can continue to eat the foods that got me here in the first place.” We don’t want to change! We don’t want to eat differently, let alone that four-letter word, diet. We work hard all day. Isn’t that exercise enough? Just give me the damned pill.

Of course, it’s not that simple. I do not mean to imply that all or even most diseases are this way. Enough are, though, that small changes could have a huge impact on our lives and the cost of healthcare in this country. We are not managing our health in a proactive way, we are reacting when something goes wrong. Unfortunately, our response is to take the easy way, take a pill. Many of our troubles stem from the foods that are offered for us to eat. We are like kids on Christmas morning, looking at all the wonderful foods spread out before us, pre-constructed, wrapped and ready to rip open.

So I see patients where these drugs are enablers, the guy with acid reflux can continue to eat his fried food washed down with a six-pack, the lady with the high cholesterol can continue to eat whatever she likes and never break an unladylike sweat, and the super-sized pre-diabetic ladies and gentlemen can continue on their merry way, snacking at will and buying bigger pants every now and then.

Years ago, I wanted to see something call managed wellness take the place of managed care. The main obstacle was that it was difficult to come up with a payment method for a doctor that helped a patient maintain good health. There are no ICD-9 diagnostic codes, there are no good tests to bill for, nor do insurance companies often take the long view. The whole system seems to be feverishly categorizing, testing, treating, and billing. Somehow we lose sight of the actual patient and the patient is bereft of any good counsel on how to reclaim their good health. We spend many dollars testing and documenting results, monitoring compliance and adherence to treatment and at no time do we reward success. Success that could be documented and should be paid for! We need a mechanism that would make this a reality. It was toyed with in the Affordable Care Act, but that got so tinkered and amended that the cohesion of the plan dissolved in a wash of politics.

Fenugreeks in the Mall

We went walking around Arizona Mills this evening because it is too damned hot outside. As we went round and round, I spied this sign in a store entrance.



The store was Motherhood Maternity Outlet and it offered many clothing varieties as well as some creams and lotions for breasts, nipples and stretch marks. This Milky! was one of the few things that I saw that was meant to be taken internally and was clearly labeled as not for use during pregnancy.

Coincidentally, the students and I had explored the herbal teas in our market and I had expounded on one of the ingredients in a herbal supplement for increased lactation. The herb is fenugreek. I was telling them how fenugreek is an ancient herbal treatment to improve milk production. I figured that Milky! must have some fenugreek in it, so I dashed in and found these little bottles behind the counter and had a look at the ingredients. Sure, enough fenugreek seed extract was listed! When asked if I could be helped, I politely explained that I was a pharmacist and was interested to see what was in this product.

I had told my students that I had learned at an early point in my adventurous career that the proper way to dose fenugreek was to take enough as a tea or extract to the point that the patient starts to smell like maple syrup. From what I remember the phytohormones in this herb stimulates sweat glands and breasts are, of course, highly specialized sweat glands, after all. Anyway, I had been convinced by a young lady friend who was a back to mother earth type and allowed me to stay with her during the year I spent traveling around central and coastal Maine working in various pharmacies. She saved me many miles and taught me which mushrooms were OK to eat among many other wondrous things.

So there seems to be something to this fenugreek stuff. The first challenge would be to find a reliable product that contains ample fenugreek, the next would be to find a palatable way to take enough. This stuff does bother some people, causing digestive woes and sometimes aggravating asthma. But let’s get back to Milky!

Milky! contains five allegedly active ingredients as seen here. milky_supplement

This herbal tea is about $30 for a 12-pack of 2.5 oz bottles. Each bottle has just over 7 grams of the herbal blend of 5 different things and hopefully most of that is fenugreek and not the fennel to “alleviate baby’s colic symptoms,” nor ginger to “help relieve upset stomach,” nor chamomile to “ease tension in mothers,” nor rooibos tea to “deliver natural anti-oxidants,” because it likely takes at least 6 grams of fenugreek daily for a few days to get you smelling like pancakes drenched in maple syrup.
So maybe it comes close. They seem to be trying to come up with an actually beneficial product. I still worry about the other stuff in here, not to mention that there is no way to know for sure what exactly is in the product. Supplements like this one are not regulated to ensure accuracy of labeling.

I would say consult your pharmacist. Or, find a gal like my friend Trudy who was happy to pump a new mom full of fenugreek, sniff her daily, and always recommended breast stimulation to ensure a continued supply of mother’s milk.

Fenugreek is on the FDA’s Generally Recognized As Safe (GRAS) list.

Hooray for breastfeeding!


I’m happy to have phenAZOpyridine available over-the-counter. I’ve advised it for hundreds of patients, mostly women, to provide temporary relief of the discomforts of a urinary tract infection.

Phenazopyridine was discovered in the 1930s by Nobel Prize winner Bernhard Joos. Since then it has been taken by millions. It’s a pretty good drug. It’s a dye, however, that gets distributed in your body’s water and excreted in the urine where it provides an analgesic effect as well as a nice orange color. Take enough and you can cry orange tears. Happy Halloween! I’ll leave it to your pharmacist to provide the rest of the counseling.

Let’s take a look at the evolution of a brand line that starts with AZO. You’ll see here that AZO is 95mg of phenazopyridine. Prescription strength phenazo comes in 100mg and 200mg tablets. The 95mg AZO cost about 32 cents per tablet but then they added the new Maximum Strength tablet which is… wait for it… 97.5mg!





Woohoo an extra 2.5mg! The Max Strength AZO costs about 58 cents per tablet. Do you think you or your bladder could tell the difference? I think you know my answer.

For the budding scientist the company offers AZO test strips in a box of three for about $9 and it tests for the presence of leukocytes (white blood cells, a sign of infection) and nitrites. Bacteria (gram negative usually) in the urine convert normal nitrates to nitrites. These sticks would be a good indicator of UTI if symptoms alone were not enough to convince you. azotest

Cranberry juice is a popular urinary friend. There is some evidence that cranberry juice will prevent bacteria from adhering to the bladder wall so it may be of some preventive usefulness. azocran So AZO started marketing AZO Cranberry to “promote flushing and maintain a healthy urinary tract.” This product has some powdered cranberry juice, vitamin C and 100 million probiotic bacilli. It’s pretty cheap at 18 cents per per tab, but 2 is a dose so actually 36 cents. Likely will not hurt you but most likely not much value either, and since it does not treat UTI, you would pretty much have to take it every day.

You can see we are sliding further and further from Nobel Prize territory when the next product out of the chute is AZO Yeast, “Homeopathic Medicine.” There are many in the scientific community that find that phrase to be an oxymoron.

AZO Yeast

AZO Yeast

Contains 400mg of this homeopathic medicine, somehow. We’ve got a 5x dilution of boneset and mistletoe. There is some scant evidence that mistletoe may improve the immune system. I would imagine that kissing under some mistletoe would stimulate the immune system more than this product!

The latest entry is AZO Bladder Control with Go-Less! This is pumpkin seed extract and soy extract. Sigh.

Go Less

Go Less

Perhaps the diuretic effect of pumpkin seed helps relieve fluid pressure, but aren’t we trying not to pee? There may be a slight increase in testosterone which we hope targets pelvic floor muscle. There’s a lot of hope and faith going on with this stuff. The soy might help if you are in estrogen deficit by slowing the atrophy of the connective tissue where bladder meets urethra. Hopefully.

I’m disturbed by this bastardization of pharmacy. We are now mingling science with homeopathy, herbalism, and snake oil hucksterism, all in the name of making more bucks. There is scant science in most of these brand name extension products.

I was going to mention the product Uricalm which contains 99.5mg phenazopyridine and usually sells for less than either AZO products.

99.5mg phenazo

99.5mg phenazo

Then I saw their products line and wanted to scream. Yep, more brand name pimping! Stick with Uricalm if the price is lower. Uricalm Intensive is simply aspirin, acetaminophen and caffeine, which is essentially Excedrin. Of course, there has to be a Uricalm Cranberry. Skip it too.

This is the third of my “Below the Belt” trilogy and I promise to explore other areas of the market again very soon.

My collaborator and research assistant on this post was Megan Handley, soon to be a PharmD, from the University of Arizona College of Pharmacy.

Megan, Hannah, and Thao provided much youthful energy to this trilogy and we had many fun and informative discussions of our findings. It is reassuring to know that bright youngsters like these will be my pharmacists when I get old and need any drugs.

Feminine Hygiene Ruminations

Feminine Hygiene

Feminine Hygiene

I was discussing the various products in the line of Monistat products and mentioned the time Monistat-1 was launched and we started dispensing it at the campus health center. It sounded good. Why not treat in one day when the alternative was 3 or 7 days of treatment? Who wants to have a creamy crotch any longer than necessary?

It turned out that our women’s health providers started having women show up with very sore bottoms and it was clear that the severe vaginal irritation was due to the concentration of anti-fungal in the one day ovule. We had already noticed that the new product was not miconazole, as is Monistat, but tioconazole, a close relative. Although the product tested well in clinical trials, the concentrated drug was too much for the young vaginal tissue of our students.

We expressed our concerns to the manufacturer, not only with this extreme reaction, but also with the use of the Monistat name for a different active ingredient. If you look at that section of the feminine hygiene aisle now you will see Monistat-1, miconazole, and from the makers of Monistat: 1-Day, tioconazole. I have to give them credit for walking back the use of the Monistat name on tioconazole.

Of course, that didn’t stop them from taking advantage of the Monistat name to create the “Complete Care” line of products to deal with itching, chafing, odor, and general vaginal health. That’s five new products to cram into the fem-hy section of the store. There’s a vaginal health test that checks for an abnormal pH and the two testing swabs are accompanied by a little tube of itch cream to treat the itch that made you suspicious in the first place.

The Stay Fresh freshness gel promises long-lasting freshness that lasts for 3 days by protecting vaginal balance and working with your body to restore feminine freshness with a glob of gel about the size of a nickel. That’s not the price, though, you get four applicators or uses for about $20. Oh, it is paraben free, however. I think our market’s current slogan of “Fresh and Friendly” is appropriate to mention here.

Then there is the Probiotic plus Antioxidant that promises both vaginal and urinary tract health. The oft-repeated claim is “clinically shown to help maintain vagina AND (sic) urinary tract health,” although the fine print points out that these statements have not been evaluated by the FDA and “This product is not intended to diagnose, treat, cure or prevent any disease.” Take one capsule daily to maintain vaginal health it says, but take two to maintain both. Oh, and remember vaginal balance is so easily disrupted that you should take it EVERY DAY! (this time caps are mine). FOREVER! What a racket. I am extremely skeptical that this product is of any value. All it really claims to do is “support a healthy vaginal pH.” Well, I’m here to tell you that I’ve supported a healthy vaginal pH since I was 18, so skip buying this and send me the money.

Ladies, if there is a lesson here, it is to always keep your vagina balanced. Just like in maintaining life balance, you’ll need a good variety of stimulating activities, quality down time, and lots of fresh air.

No Balloon? No Party.

As a young pharmacy intern, one of my first encounters with somebody embarrassed buying condoms happened at Laverdiere’s Drug Store. A young man had been hovering near the pharmacy check out counter and finally, when other customers had departed and he had only me to deal with, he quickly grabbed a box from the condom display and brought it up to buy his box of three original Trojans. I could see he had a dollar bill clutched in his hand and when I rang it up and told him the total he looked confused, worried, and sad all at the same time.
“That will be a dollar and three cents,” I told him.
He stammered back, “it says ninety-nine cents!.”
“Well there’s four cents for the tax,” I replied, and now he looked downright terrorized.
“If you have to hold them on with tacks, forget it!” he cried and started to beat a hasty retreat.

I was able to coax him back to the counter and give him some solid advice on proper condom use and kicked in the three cents so he could go on his merry way.
The scenario is apocryphal, of course, and comes from an old pharmacy joke that has probably been around as long as condoms and taxes. Truly though, I have counseled many a young man on condom use and other ins and outs of safer sex.

Early attempts at condoms or some sort of penile protection were usually cloth based, linens and silk mostly. This reminds me of the even older joke about the traveling salesman who revisits a lass that he had frolicked with on his last circuit through town only to find that she had a fair-haired young son about whom he remarked, “He sure is a fine young lad.” The woman shot back, “He should be fine, he was strained through a silk handkerchief.”

We tend to give the Romans credit for the first use of the more effective goat bladder condom. An Italian doctor, Gabriel Falloppio, is believed to have taken sheaths of lamb gut, tied one end with a ribbon, and anchored on the erect penis with another ribbon. “Look! A present for you!” These were often rinsed out and reused and can be seen hanging to dry in some late 16th century artwork.

Today we have a wide assortment of condoms available, offering a variety of sizes, shapes, colors, flavors and scents. Package claims even stretch into the realm of providing an enhanced sexual experience. Some focus on sexual pleasure with promises of arousal, intense pleasure, double ecstasy, and even intensified charged orgasmic pleasure! Wow! I must admit that I have not used a condom in many years and had no idea they were electrically charged nowadays!

We do not have electric condoms yet, although there is a vibrating ring with its tiny little battery, so we’re getting close. The condoms in question use a “intensified lubricant” and strategically designed and placed “ribs” or ridges to provide the charge. “Price check on Charged Orgasm condoms on register three!”

This all started when I was unlocking the condom case one morning and I noticed the huge variety of condoms (and even vibrating rings!) that we had in stock, all sporting a variety of sexy claims. I wondered how they did it. Chemicals must be used that create these sensations and so I asked my students to have a look at the ingredients and report what types of things were used in or on condoms to support the package claims.
What if somebody had an allergic reaction to a condom? Would they know what caused it? The ladies began a passionate pursuit of new knowledge…

This turns out to be a daunting task. It’s a secret! Not much info is provided beyond whether the condom is latex or not, have nonoxynol-9 as a spermicide, and then simply state if a lubricant is present. Or in the case of the Climax Control versions, that benzocaine, an anesthetic, is used. There is a “Fire and Ice” Trojan which I suspect may use castor oil (!) for warming and menthol (!) for cooling, although I have no way to verify that. I did find hydrogenated castor oil listed as an ingredient in some personal lubricants.

We were able to find that various things may be added to the latex during the vulcanization process, but that is proprietary information. We were able to learn from secondary sources that condom manufacturers sometimes use the milk protein, casein, and the lack of casein supports the claim of “Vegan Certified.”

Sir Richard

Sir Richard

We found that parabens may be used. Parabens are another one of those chemicals commonly used in our cosmetics and personal hygiene products, ostensibly to prevent bacterial growth. Parabens have been found in breast tumors, although no causal relationship has been established. Parabens are thought to be endocrine disruptors (remember the Triclosan blog?) and have estrogenic activity, although, according to the FDA, “they have been shown to have much less estrogenic activity than the body’s naturally occurring estrogen.” Great. I’d be concerned about soaking my dick in estrogen every night! OK, OK, maybe not every night.

Glycerin, a hydroscopic sugar alcohol, is a relatively safe lubricating liquid with a variety of uses, most relating to its hydrating effect. Being a sugar alcohol, it is somewhat sweet and edible. However, there are numerous reports from women of increased frequency of yeast infection when exposed to glycerin found on condoms.

So here’s the rub. The FDA addresses condom labeling under the general device labeling regulations with addendum for expiration dating and warnings about latex allergy when appropriate. There is no regulatory compulsion to disclose anything about other additives or chemicals used in the vulcanization process, lubricants, or anything they care to squirt into that little foil pouch.

So its up to you to cover your own ass, so to speak. Choose wisely, grasshopper. I would recommend the KISS principle here: Keep It Simple, Stupid, you don’t need a chemical bath for your penis to achieve intense pleasure, nor should you expose your lover to unknown risks.

Here are just a few of the varieties that we have in stock:



Trojan sports the biggest and longest product line. See it here.

Durex is also in the game in a big way.

Sir Richard promises fewer chemicals and for every condom they sell to you they promise to give one to a poor person in a developing country.

Research assistants: Hannah Shorb, PharmD candidate Midwestern University, Glendale and Thao Truong, PharmD candidate University of Arizona

Kale Marries Brussel Sprout! Start Family!

In this day and age of GMOs it’s nice to see that traditional cross-breeding is still a major agricultural force. Over the past 15 years, a UK seed company has been cross pollinating brussel sprouts with kale, hoping to produce a nutritious, supermarket-ready veggie. Brussel sprouts are one of my favorite super foods and kale, of course, is the latest darling of the Whole Foods gang. Now, thanks to Tozer Seed Co., they have come together to give us the kalette, aka brusselkale, soon to hit a produce section near you. This is the coolest cross breed since broccolini!

Cross pollination is a centuries old practice that simply involves using pollen from one plant being (ahem) introduced onto another plant’s stigma or stamen. In the case of the kalette, it’s the marriage of two plants in the cabbage family!

I Recant! Soccer Moms Rejoice!

I’m not even two months into this blogging thing and I’m very happy to issue my first correction. Many posts ago, I mentioned that Capri Sun containers were not recycleable. A cool company called Terracycle has actually been recycling those pouches since 2007. Shame on me, good on them. They will even pay 2 to 3 cents per pouch depending on how many are sent to them. The program works best for larger groups like schools but individuals can play too. Terracycle already has over 40,000 schools participating. I happened across a little article in the East Valley Tribune telling how a local school collected 80,000 pouches and earned $1,300 which they gave to AZBrainfood. Although I am not a big fan of these sugary drinks, I hope that if you are buying Capri Sun, you are making sure those pouches get recycled. Terracycle makes it easy.

Terracycle pouches

Terracycle pouches

In Praise of Red Grapes

I have to sing the praises of red grapes. All grapes are good, I like red the best. Our market has them on sale at 75 cents per pound right now and I have been eating them at work and at home. These are very sweet and very satisfying, good at keeping hunger at bay.

The sweetness factor had me thinking about the source of that sweetness, which comes right from three main sugars, glucose, fructose, and sucrose. Since sucrose in essentially glucose and fructose in one molecule, really two sugars. Luckily, the natural delivery system modifies the glycemic effect and grapes do not cause a large blood sugar spike thanks to the fiber content. So, here’s a cup of medium-sized red grapes, which is 148 grams on my digital kitchen scale:

One cup  of grapes

One cup of grapes

The great news is the 100 or so calories that are in these tasty bites. That’s 42 grapes, by the way, which will keeping my snacking fingers busy for quite a while. These are chilled, and for more fun in the desert heat, I often freeze a bunch of grapes, making a very refreshing snack that takes even longer to eat! Along with the 23 grams of sugar you get a gram of protein, a dash of omega-3 and omega-6 fatty acids, about 100 units of vitamin A, 15mg or so of C, about 4 mEq of potassium and a bunch of other fine nutrients. Most grapes are about 80% water, by the way.

Resveratrol is also found in grapes and many believe it helps to offset other bad dietary habits, although this is inferred by looking at the French, whose low incidence of heart disease despite all those tasty pastries and cheeses, is often attributed to higher wine consumption and thus more resveratrol. Peut-être.

Health-wise, sweet red grapes beat out a candy bar each and every time and are easier on the budget! Frozen, they can even replace ice cream. Of course, grapes are fun too! They can be tossed into the mouth, shared with a lover in a variety of ways, are very portable and not at all messy unless you want them to be.

Are we not Men?

I’ve worked in the same pharmacy for five years, so many of my patients and customers are very familiar to me and I to them. It creates a nice comfortable rapport and has led to many good healthy discussions and changes in treatment, lifestyle, food choices and ultimately positive outcomes. Those “wins” are why we do what we do in health care.

I joined this large state-wide company of over 100 stores because I have a good relationship with our company leaders. Our takeover by an even larger corporation, however, is taking us deeper into the new American business paradigm of production metrics and satisfaction surveys. Most large companies use these tools. The tools are flawed. Metrics can be manipulated. Customer surveys are stilted and sometimes silly. I recently reviewed our survey comments and found one that called us all morons yet gave us a highly satisfied grade! Surveys done by associates (i.e. employees) are preceded by weeks of direct mail and in-store propaganda. It all goes to create a false snapshot of reality.

It has led to my realization that when a company gets gobbled up by a bigger fish, even continuing leadership people are challenged with new directives and goals leading to uncertainty and insecurity. The bean counters seem happy though.

But why I really started this post was to talk about the disappearance of humanity from American Business. Yes, the surveys and metrics contribute and so does the growing disparity between CEO pay and average worker pay. In 2012 the ratio of CEO compensation to worker was 273 while in 1965 it was 20! In other countries it ranges from 15 to 100 but is growing as greed becomes standard practice.

It goes beyond that, of course. For many months I had this picture displayed in the pharmacy, where people waiting in line could see it. It was a great conversation starter and helped keep the line a friendlier place. It was my own photo in my own frame so eventually it was spotted by upper management and was removed from sight. So much for personal values.



A friend and colleague that recently passed away, was a renaissance man who enjoyed culture of all kinds, great art, and just plain enjoyed life. Arthur had a small line drawing, a favorite of his hanging in the pharmacy where he was manager was forced to remove said drawing when somebody saw it and deemed it offensive. Picasso would weep.

line drawing

line drawing

Of course, this leads to the discussion of why Americans tolerate guns, gore, and mass murder of children much better than we do the naked human body. Come on, people!

This may have rambled a bit, or more likely, stumbled like a drunk in a wind storm, but these things were floating around my head when I got up today and I had to get them down somehow. It’s all connected.