A pharmacist's look at the supermarket and beyond

Month: March 2017

Va Va Land

There are some pretty nifty developments in the realm of women’s health. We have come a long way from the days when I had the rather unique opportunity to learn how to install an IUD. Not too many pharmacists get an opportunity like that! Over a decade ago, as Pharmacy Director at ASU Campus Health, our wonderful Ortho rep set up a training class on-site and I was invited to attend along with several doctors and nurse practitioners. We sat in front of life-sized pelvic models similar to one seen here and did not have benefit of ultrasound or other technology, so using just sight and touch, used a small device to carefully place the Paragard IUD. On our models, there was a little trap door in place of pubic hair that we could lift open to see if we had properly placed the IUD. A training session that I will never forget! Yes, I got right the first time! I still have my stunningly stylish Paragard tie tack!

Speaking of vaginas, I came across a bit of trivia. The Walt Disney company is credited with releasing the first film to use the word vagina! Apparently working with funding from Kotex, the animators got to work on explaining menstruation. A ten minute restoration of this animated classic can be seen here on YouTube. I do find it hard to believe that the scary STD films they showed to our boys heading off for WWII didn’t mention vaginas, but maybe not.

Fast forward to modern times and we find that researchers at Northwestern Medicine have developed a miniature, functioning version of the female reproductive system. It is a small cube that can fit on the palm of you hand. This 3-D model is made with human tissue and uses artificial “blood” to allow transport of hormones and other secretions throughout the system. This technology, EVATAR, will enable the testing of new drugs without risk to patients. Imagine having a drug tested on this model, made from YOUR tissue! Ultimately the long term goal is a “body on a chip” which would use your stem cells to create tiny models for testing of various treatments for highly personalized therapies. You can take a few minutes to learn more about EVATAR here on YouTube. Someday, your doctor will harvest some of your stem cells, grow out a heart, a lung, liver, or an ovary and then test dozens of drugs and doses to see which best would treat whatever ails you. Creating a pancreas via this process may someday lead to a cure for diabetes! There is a male version on the way called ADATAR and another focused on the testicles and prostate with the working name Dude Kube.

In the meantime, as we see more and more young people opting for more natural food and drink, it is no surprise that modern women are looking for alternatives to the mass-produced, artificial menstruation products. Many women rightfully worry about exposure to bleaches and pesticides. Several new products are being marketed with moderate success, from natural sea sponges to reusable fiber products like “Glad Rags” or Thinx panties. There are also menstrual cups like the Soft Cup or the Diva cup (these cups may be referred to as catamenia cups in some literature – from the Greek, cat (pussy) -menia (blood) sorry, just kidding, although catamenia is a real word). From what I have read they require a short learning curve as well as the ability to become more intimate with your monthly visitor as well as your vag. If you want to read about one woman’s journey of discovery as she “test drives” these products visit Rachel Krantz. Considering that one woman can have about 450 periods in a lifetime and may use 16,000 tampons, pads, liners and such, its obvious that this is a big market not to mention more “stuff” in our landfills. Having reusable options seems like a good idea to me.

In world news, in Italy, the parliament is debating a measure that would have employers offer “menstrual leave” of up to 3 days per month for women with painful periods. Italy would follow in the footsteps of countries like Japan and Indonesia already offering some form of menstrual time off. It seems like a sticky wicket to me.

More world news. In a response to Donald Trump’s pussy grabbing quote, the Russian girl Punk Band, Pussy Riot, released the English language version of “Straight Outta Vagina,” which reminds us, “Don’t play stupid, don’t play dumb, vagina’s where you’re really from.” These ladies spent 16 months in a Russian jail so they definitely have street cred as fearless feminists.

And now: If your vag feels or looks a little worn out, and needs a little rejuvenation, and you can afford the procedure, and several days off work, you might consider an “Aussie makeover.” It’s suggested for a well-used or stretched out vag, or if it doesn’t match up to partner’s penis size. You can even have your labial lips sculpted! I would never have known about this, but I have the tendency to read anything I can get my hands on, especially in a waiting room.

That’s all for now, my final word is, support Planned Parenthood!

Tour de Cure

I rode in my second Tour de Cure bicycle ride last week with over a thousand local riders, including many colleagues from pharmacy. I raised over $300 which might cover the cost of a box of insulin pens for one patient and that might last a month or more. Diabetes is an expensive disease. I signed up to ride 25 miles but the final course was just over 28 miles. That’s one mile for every million Americans with type two diabetes. Diabetes is a prevalent disease. The Tour de Cure raises money to aid diabetes research. We can only hope that we find a cure soon.

I fervently hope that a cure, when found, is not suppressed. It costs Americans, all of us, either directly or indirectly, about $200 billion per year to treat diabetes. You can bet the medical-industrial complex does not want to see that money dwindle away. I’ve been hearing rumors about this sort of thing ever since pharmacy school, so many years ago. Rumors of drugs that were so effective that they essentially fixed the problem, but the company owning the rights would manipulate the molecule so as to cripple its effect or limit its effectiveness, thereby requiring repeated dosing to hold the problem or condition at bay.
It’s our new business model, after all. We are encouraged, or forced, to “subscribe” to so many of our modern conveniences, lease our cars and gadgets, and constantly renew our prescriptions. Let’s not allow this to happen with diabetes or any other of the diseases or conditions that we all walk for, run for, bike for, or otherwise donate our time, energy and money. I dream that part of our ideal national health care policy is to be sure that basic research, funded by tax dollars or donations, reveals all results to we the people. I know, naive and I didn’t really intend to stray down that path of negativity.

As I pedaled those miles, I took time to ponder some other facets of diabetes, beyond the staggering cost of treatment. There is lost productivity, as well, of course, but it seems that few of the players devote serious energies to managing type two diabetes without coming to me for drugs. Take a pill! If my corporate overlords allowed it, I could spend more time with these patients. Being in a supermarket presents a tremendous opportunity to do some coaching on buying habits and encourage smarter choices. We would spend most of outr time going around the perimeter of the market, limiting exposure to the center which is mostly stocked with processed foods. It does not have to be myself or even one of my staff pharmacists, I’d love to see an appointment system set up to have our at risk patients go shopping with an expert in nutrition. Unfortunately, without a significant charge to the patient, there is no return on investment. In fact, if some of these folks got healthier, we might fill fewer prescriptions. Ye gods, NO!

The baby step here is for patients and their loved ones to start small, by adding some fresh produce to every day’s menu, eliminating soda, whether sugary or artificially sweetened, and slowly sneaking in some exercise. It could happen. It might start with a friendly nudge.

To learn more about diabetes, you must start at the American Diabetes Association! Check it out! I invite you to ride with me next year.

Here is part of our pharmacy fridge. Probably close to $50 grand in there at the moment and that replenishes about once a week.

My Tour de Cure 2017:

My Tour de Cure

Health Care Extremism

The latest attempt to repeal and replace “Obamacare” has failed, despite a Republican controlled Congress and a president that ran as a Republican, but is demonstrably a party of one. The Ryan plan, dubbed the American Health Care Plan, remained too socialist and liberal for the conservatives, too generous to the wealthy for the Democrats, and too weak to be a meaningful replacement for the more robust ACA. I’m glad it failed. It was an extreme and poorly crafted alternative. This is the best they could come up with in seven friggin’ years??!! And then they were willing to bend over for the “Freedom” Caucus and demolish women’s health care. Spineless tools.

Not that I am all that happy with the ACA. Most folks agree that certain aspects of Obamacare are winners,the pre-existing condition requirement, the age 26 coverage as a dependent, and the expansion of Medicaid, seem to be the top three. Major mis-steps are the pricing structure that allows healthy individuals to forego coverage unless they pay a penalty, and the mandated coverage of certain items that are not universally needed. Either way, a person starting out in the workforce has a new expense that will delay many desirable milestones as a contributing citizen. It makes it more difficult to buy that first home, start a family or own a business, and erodes any attempt to plan for the future. Insurers were left offering policies with unneeded coverage line items that inflated premiums and made plans unattractive to potential buyers. That whole pricing/minimum coverage strategy coupled with tax implications are the biggest flaws of the ACA.

My question is: Why must we repeal and replace the entire Act? That’s extreme! Shouldn’t we be gathering our experts and stakeholders to work with Congress and find a workable solution? Congress should be representing the best interests of its constituencies, not special interests such as Big Pharma, behemoth insurance companies and their CEOs, or other members of the oligarchy.

Medicare has worked relatively well for decades. This despite the government “borrowing” all of the money that we have paid into the trust fund itself. The funding strategy is not as convoluted as the ACA and with proper changes in design, intelligent limits on coverage, and aggressive fraud deterrence, a national health care plan is possible. We should cover every American with a basic level of coverage starting with first breath. A balanced fee structure could be designed using a person’s age and income (ability to pay) to determine a reasonable premium. Note that I said basic coverage, you can read that as catastrophic coverage if you like. The main point is to provide federal coverage for all. Once we agree on that we can start to discuss incentives for healthy behavior and limits to care for self-inflicted conditions. We can balance payments according to age and ability to pay. We could even consider levels of coverage above the basic as people entered the workforce while creating incentives for people to seek gainful employment. States could take action to help those at greater risk and lower abilities. I’d still like to see everyone contribute to match their abilities.

This would not mean the end of more robust plans, which could be offered by employers as part of an attractive benefit package. HSAs could easily survive.Once the baseline coverage foundation is established, building on it in the marketplace, either through private purchase or as part of a group (be it employer or other groups), can fulfill that burning Republican desire for capitalism in health care. Although we need to be very careful how this is crafted.

I wonder if we see this extreme behavior to completely destroy Obamacare as a reactionary dislike for our first Black president simply because he is Black. I’ve told my Senators and Representatives that I want the ACA made better, not destroyed. That is how we made America great, by building on our successes and revising and improving on ideas that didn’t meet expectations. Not by the extreme politics that we are seeing now.

And while we are at it: One of the components of the ACA was to limit health insurance executives to $500,000 in tax deductions. HHS Secretary, Tom Price stated that it is unAmerican to single out these individuals.
I agree! Why not have that $500,000 limit on everyone? We could exclude charitable donations to true charities (NOT PACs!). No one is singled out. Problem solved!
Who the Hell needs more than half a million in tax deductions??? Yeah, I can think of one guy too.

Finally, no matter what we do, the end result should be something that can be easily understood by the average Joe. No more of the coverage gap, you pay this % we pay that %, Big Pharma gives you a discount (wink, wink), spend this much, we match, check out of pocket, cover this today, not tomorrow, authoritarian health rules. I must be able to explain coverage to my patients! Preferably in two sentences! That would be Great!