SUPERmarket PHARMACIST

A pharmacist's look at the supermarket and beyond

Page 2 of 13

Oh Those Golden Grahams!

My supermarket had the Valentine’s Day candy out on the shelves before the Christmas clearance had been fully marked down. I always recall the son of one of my ASU technicians whom I met while he would visit us back in the time he was taking classes. He is now married with kids, but back then he was very single. I used to tease him that he always got confused this time of year because he couldn’t tell the difference between Valentine’s Day and Palm Sunday. Perhaps he should have been eating more graham crackers.

Minister Sylvester Graham, a married man and a member of the Pennsylvania Temperance Society in the early 1800s, who became a big believer in abstinence and vegetarianism, is usually credited with the invention of the graham cracker. He was ahead of his time in his recommendation for the use of whole wheat in bread-making and his disdain for branless, additive-laden white flour. He even published a Treatise on Bread and Bread-Making and during a cholera outbreak in the 1830 began lecturing on whole foods and healthy habits. These healthy habits most certainly did NOT include masturbation. In fact, his rigorous plan included cold baths, loose clothing (but not loose women), and a meatless diet in order to keep the libido in check. It’s not clear if he or one of his acolytes developed the Graham cracker which was touted as an essential part of the diet for those wishing to avoid masturbation or excess sexual activity.

His lectures targeted at young men spoke of the evils of spices and hot food. His ideas were not all crazy. He may have liked talking about sexuality, which was a part of his lectures. In my home state of Maine, one of his lectures was aborted by a mob of citizens too shocked to allow him to discuss sex in front of a mixed audience.

Remember, this was the early 19th century, when society was becoming more urban (and urbane?) and religions still tended toward severe chastity and restraint, proclaiming sex was only for procreation. I imagine many people found the crackers helpful if only as a placebo to curb their lustful urges and activities. Of course, combining graham crackers with chocolate and marshmallow and heating it up over a fire is far different than the pastor’s intention. Some might even say that s’mores are an aphrodisiac. Maybe Sylvester was on to something after all.

Almost a hundred years later, Nabisco, mass produced graham crackers with a different formula and even highlighted the “graham” taste with the addition of honey. You can see here that today’s honey grahams contain a mixed of enriched white flour and whole grain (graham) flour.
Sylvester Graham would not approve.

Today we have a multitude of graham crackers on our shelves and I don’t think any of them would meet Pastor Graham’s standards.

(Somehow I cut off the last couple paragraphs and pics in the first upload. Sorry)

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End of Year Hijinks

The end of the year is always an interesting time in the pharmacy. Some patients are trying to hold off until the next calendar year when they will be out of the coverage gap while others are trying to squeeze in every refill possible because they are beyond the gap or their insurance is changing or co-pays are going up next year.The ones that are trying to hold off are a particular challenge because they often put their health at risk by skipping doses or even entire weeks of medication. We strive to find solutions for these folks, but I fear that much of this behavior flies under the radar and we simply don’t know it is happening. We use partial fills when possible and try to find manufacturers’ discount cards for the more expensive brand name drugs. (see several previous blog posts) Unfortunately, our tool of a Congress has made it illegal to offer these discounts to people that are Medicare eligible. Not even enrolled patients, mind you, “eligible” patients. So even if you opted out of coverage you still cannot take advantage of these discounts! Our Senators and Representatives have no such restrictions, of course, enjoying the best health care coverage possible, on our dime.

So, yes, we have found some of our patients reducing their insulin dosage or simply doing without. Scary. Others forego blood pressure drugs, or even heart meds. It is quite common for people to use a variety of ill-conceived strategies to stretch their supply of medication. Their interactions with their insurance companies must be quite interesting.

One of our patients was recently approved for Enbrel and since he was past the coverage gap and into “catastrophic” coverage his co-pay was only $200. This persuasive and persistent patient was able to convince his Medicare part D plan that he was going on vacation in early January and got approved for a “vacation override” for another 4 weeks of Enbrel. Score! Most patients are not so lucky, each claim that we try to squeeze in before the end of the year is often rejected with a “refill too soon” message that indicates the date it may be filled. There is no easy way around this.

Another patient, with a Health Savings Account (HSA) thought it would be clever to refill all his inhalers, nasal sprays, and anything dispensed in its original container so that he could charge it to his HSA and then return them all for cash. Dude, that’s genius! Luckily, he asked about our return policy before actually proceeding with this scam. Federal law does not allow returns of medication, regardless of packaging, nor would we participate in this attempt at fraud. Dude, you’re busted!

Most of our chronic pain patients understand our guidelines and will not even ask about early fills. We did get a few however who questioned our calendar math, trying to get a fresh supply of oxycodone before the New Year. We are merciless and will not fill schedule 2 Rxs until there is 90% utilization of the previous Rx from the date picked up (not date filled, that may differ). We only had a handful that tried to push the issue. Being closed on Christmas and New Year’s day we often had to point out that even if Christmas was day 27 of 30 (90%), on the day after they should still have 2 days of medication remaining. Patients that continue press this issue end up with us taking a closer look at their utilization over a longer span of time than one month. We cannot be too careful when close to 100 people per day are dying from opioid overdose! Patient education and counseling becomes critical in these situations.

There are also a number of patients that have prescriptions that can be filled before the end of the year that will wait in our “ready” bins until the new year because the patients do not have the funds to pay their co-pays. This gives them about two weeks to come and pick up their meds.

I write this on New Year’s eve and I will tell you that next week will be even more fun as we deal with huge (or is that “yuge” now?) numbers of our patients having new insurance coverage and a fair number of them with no new insurance card, or changes in coverage and co-pays that they did not expect. It is one of the most challenging weeks in a retail pharmacy. Believe me!

Here is a chart from Kaiser that illustrates 2017 Medicare part D coverage:

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Mind Games

Here’s a little mental exercise to play with:

We do a huge part of our prescription business in mental health medications. Some of these brand name meds are quite expensive and I would like to focus on aripiprazole, aka Abilify, for this thought experiment. Abilify is indicated as an adjunct or “add-on” therapy in the treatment of depression. There are a couple studies showing that it is more effective than placebo when added to existing SSRI, such as Zoloft or Paxil) or other therapies such as bupropion. Patients report both success stories and miserable failures when taking Abilify. Half of the package insert is a discussion of side effects and adverse reactions. In my opinion this is a drug of some moderate usefulness, high cost, and very significant risks.

One of the state behavioral health plans covers Abilify, and interestingly insists on brand name. I can only assume that some sort of rebate to the plan is in place. Otherwise, why spend more of the taxpayers’ money than is necessary? The monthly cost of Abilify is about $1,000 per month. Abilify is often used to boost the therapy of a depressed patient. So I postulate: If we have a depressed patient, being treated with moderate success with one or two generic agents, and we are considering adding Abilify, why wouldn’t we consider another choice? I would suggest that the taxpayers could be well-served by simply giving the patient $500 cash each month! If I were moderately depressed and on a state welfare plan, $500 per month might be a huge factor in changing my life and lifting my depression. An extra $500, with continued counseling, could change my life in ways far beyond the power of a pill like Abilify. I doubt the plan is getting a 50% rebate, so $500 likely saves the taxpayers plenty of money. Even if the stipend was $300, there would be a noticeable and positive on that patient’s life and lowered taxpayer cost.

I, for one, would rather see my cost reduced and my taxes dollars be used in more insightful and innovative ways. Obviously this is just the nugget of an idea and needs refinement but don’t be afraid to consider this kind of out of the box thinking when it comes to recreating health care.

Think about it.

the wall

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Drugs and US

Many of the shady practices of our healthcare system are getting lit up as we continue to question exponentially increasing drug prices, the legalized creation of millions of opioid addicts, exorbitantly paid health insurance and pharmaceutical executives, and cancer doctors that benefit from expensive drug treatments that may or may not work. This is what happens when we let free-reign capitalism takes over our health care. Greed rules, patients pay, suffer, and die.

Once upon a time, I thought Mylan was a pretty good generic company. They produced a good product and had fair pricing. Then they got greedy. Heather Bresch has been CEO of Mylan since 2012 and with the help of her family pushed profits and her salary to the point where we started to notice. The $608 price tag for Epi-Pen has garnered headlines and congressional hearings. Plenty came to light in these hearings, including that Heather thought her $18.9 million salary was fairly normal for her industry. Last year, Mylan incorporated in the Netherlands, dodging millions in US taxes.

It turns out that Heather’s dad is a US Senator (since 2010) who was instrumental in landing Heather a job at Mylan. Daddy Joe Manchin is known as a “bipartisan” senator by many and as a “DINO” (Democrat In Name Only) in other circles, because of his breaks with Democratic leadership in voting to defund Planned Parenthood, support of coal, and not endorsing Obama in the 2012 election. To be fair, Sen. Manchin did co-sponsor a balanced budget amendment, introduced the Silver Alert Act, and helped put hydrocodone into schedule II.

Mom got into this act also. In 2013 Gayle Manchin became president of the National Association of State Boards of Education. This followed her appointment to the West Virginia Board of Education by her husband, who was at the time, governor of West Virginia. Momma Gayle thought that Epi-Pens were the coolest thing around and that every school in the nation should have several on hand. She was quite successful in her campaign and Epi-Pen popularity skyrocketed right along with its price.

We call all that shenanigans. Congress calls for a possible anti-trust investigation. A few politicians even dared to mention that we end the ban on Medicare being able to negotiate drug prices! Why the Hell not??!!?? We are being exploited by these greedy corporate weasels and their tools in Congress! There are over 10,000 congressional lobbyists, 100 Senators and 435 Representatives. That’s almost 20 lobbysits for each of our elected “representatives” and I use that term loosely. Look here for the top 20 BIG spenders! OpenSecrets.Org has some good info, including looking at the new phenomenon of “almost a lobbyist, a la John Boehner. As I said, tools, bought and paid for! Be very careful who you re-elect!

We discussed health insurance CEO salaries last year in this very blog. What about pharmaceutical manufacturers? Well, Johnson & Johnson’s William Weldon, took in $29.8 million, and Pfizer’s Ian Read, received $25.6 million. Abbott was right up there in the $25 million range and we know that even a generic company like Mylan paid its CEO close to $20 milllion. Is that really necessary? Even more unnecessary is that over the last ten years Big Pharma has plundered over $700 Billion in profits from the sick and the dying.

Speaking of the sick and dying…
A fairly meticulous study based on an analysis of the results of all the randomized, controlled clinical trials (RCTs) performed in Australia and the US, reported a statistically significant increase in 5-year survival due to the use of chemotherapy in adult malignancies. Survival data were drawn from the Australian cancer registries and the US National Cancer Institute’s Surveillance Epidemiology and End Results (SEER) registry spanning the period January 1990 until January 2004. The authors deliberately over-estimated the benefit of chemotherapy if the data was uncertain. Even with that fudge factor, they concluded that chemotherapy contributes just over 2 percent to improved survival in cancer patients.
Currently, doctors are paid by a simple formula: the average sales price of the drug, plus 6 percent. Pretty generous for a drug that might coast ten grand , right? But what if the drug is sold to the doctor for $5,000, and is paid by Medicare at the full $10,000. In that case, which is apparently a likely example, the doctor not only gets the 6% ($600), the doctor also pockets the extra five thosand dollars paid by Medicare, i.e. YOU and I! Changes in this scenario are being offered by the Obama administration but are being vehemently opposed by BIG Pharma, physicians groups, and “fake” patient organizations which are funded by BIG Pharma.
And you wonder why chemo is so readily offered. Check this out on snopes.com.

I’ve discussed the opioid problem before and some of the weird ways that we pay for these drugs. This PDF from the American Society of Addiction Medicine has most of the latest numbers. Drug overdose is the leading cause of accidental death in the United States. Here is a great article from the American Journal of Public Health that describes, in depth, the depths of Purdue’s marketing of Oxycontin, including the free giveaways like the music CD, “Get in the Swing With OxyContin” and cute little stuffed animals oxy teddy bear and nifty fishing hats: oxy-hat If you don’t think highly educated doctors can be influenced by these trinkets, the free dinners, and the island “educational” get-a-ways, you should come and spend some time in my pharmacy.

Maybe the $3 billion offered by Mark Zuckerberg and Priscilla Chan will help to change things also. Interestingly they said, “The first disease to be wiped off the face of the earth must be ignorance. The health care industry has impeded progress because it has failed miserably in the effective use of available data. It has been the poster boy of ignorance.” Yes, the health industry has failed miserably, in large part intentionally.

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Cholesterol: the Good, the Bad, and the Sexy

Billions are spent in this country to lower cholesterol blood levels. The two newest agents would cost $14,000 per year, FOR THE REST OF YOUR LIFE! Or at least until something better comes along. It’s a safe bet that the something new will NOT be cheap!

I have been thinking more about things that we have labeled as bad for us in such extreme ways that we may have overreacted and caused ourselves more harm than if we had just tried a little moderation and try to “act naturally,” meaning use our bodies as they are designed. As I discussed, some sunlight is essential for our bodies, particularly for synthesizing Vitamin D. It occurred to me that many of our issues regarding high cholesterol are a result of our modern lifestyle and nutrition. In order to see how we arrived at the point where over 70 million of us in the United States have high cholesterol (actually high LDL, AKA “bad cholesterol”), we must first have some idea what roles cholesterol has in the healthy body.

Cholesterol is an interesting molecule, on one end a -OH (hydroxyl), making it an alcohol and slightly water soluble, then four hydrocarbon rings, the hallmark of a steroid, and finally a hydrocarbon “tail” which is the oil soluble portion of the molecule. These characteristics give cholesterol its unique qualities. Cholesterol is transported around the body via the blood by lipoproteins. That is where the infamous LDLs and the happy HDLs come into the story. The cholesterol carried by these proteins is the same, only the proteins are different.

Cholesterol is a part of virtually every cell in your body, maintaining cell wall structure, integrity, and function. It is the key starting material for the sex hormones for both genders, for the corticosteroids, and bile salts, which are essential for digestion. Cholesterol is sexy beyond its conversion to testosterone, estrogen and progestins. Cholesterol and related sterols are part of sperm production, transport, and even seem to play a role in capacitation of the sperm after ejaculation. When sperm come in contact with various sterol-binding biochemicals produced by the uterus the sperm is “turned on” and now able to fertilize the egg. Changes in cholesterol levels have been linked to changes in vaginal lubrication, pH, and possibly other factors affecting female fertility. Every sexual act requires cholesterol, with climax and ejaculation consuming some cholesterol each time. To some degree, sex (yes, even by yourself) directly lowers cholesterol, not to mention the other healthful benefits for mind and body.

Cholesterol is converted to vitamin D as discussed previously in this blog. It is also critical for serotonin receptors and other neurotransmitter receptors. It protects our nerve fibers and plays many roles in the brain, many yet to be clearly defined.

Obviously, dietary sources of saturated fats plays a role in the soaring incidence of high cholesterol. However, when seeing all the important functions of cholesterol in the body, I cannot help but wonder if our modern way of life, beyond nutrition, also plays a role in our dysfunctional lipid profiles. I already discussed how we have been taught to shun the sun. Could this avoidance of a normal biological process that uses cholesterol be a factor in higher cholesterol? I recently read that millennials are having less sex than previous generations (mine included!). Could this reduction in sexual frequency also contribute to higher cholesterol? There are some studies looking for a link between SSRIs and other psych drugs and high LDL cholesterol. Are we monkeying with normal biological pathways that require cholesterol for proper function and thus raising cholesterol levels? Are we denying our bodies the fun and frolic that keep us healthy?

Human physiology is amazing and its complexity continues to hold many secrets. Our biochemistry is a wonderful dance of chemical reactions, all trying to reach equilibrium and all part of a great feedback system that strives to keep us going. All those chemical reactions will only reach final equilibrium when we are dead. We have learned that when you tinker with one part of a biological process with drugs or other exogenous material that we can get unexpected results or “side effects” such as the dry cough from the buildup of bradykinins due to ACE inhibitor drugs.

It is clear that we function best when we eat mostly unprocessed foods low in saturated fats, and live an active lifestyle with regular exercise and sexual activity. Get outside, move around, make love, laugh, eat healthy, and you may find high cholesterol does not come knocking on your door. When I pay attention to what I eat, get outside and walk or ride my bicycle, and have some time to frolic, I not only feel better, my lab work shows numbers like this:
Cholesterol: 136
HDL: 48
LDL: 68
Those are my last lab results.
They took 3 blood pressure readings:
Blood Pressure Reading 1: 120/70
Blood Pressure Reading 2: 130/80
Blood Pressure Reading 3: 122/80

I report all this to show that even a man in his sixties can make lifestyle choices that lead to good health without pharmaceutical assistance. Somewhere around 25 million people take a statin drug to lower cholesterol. What if we didn’t just look for an easy answer like taking a pill and embraced cholesterol as a vital part of us that can be harnessed and utilized for good physical and mental health?

I believe that it is possible. Live and love!

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D3D2: Into the Light

Vitamin D2, 50,000 units, is a fast mover in our pharmacy. This baffles me, because we have known for quite some time that vitamin D3 is a far superior form of vitamin D. The cool thing about D3 is that our bodies can manufacture D3 from cholesterol and exposure to sunlight, specifically, UVB light. I’m not going to go through the hard science here, but I do think it is fascinating and worth your time if you are so inclined. Vitamin D is important for your bones, your muscles, and your mental health!

I’ve been doing a lot of walking lately, getting ready for the Susan G. Komen 3-Day walk. I was about 3 miles into a morning walk when a fellow motioned to me that he wanted to talk to me. I turned off my headset and he proceeded to tell me that this was not the best time of day to get my vitamin D and started talking about “solar noon” which he described as from after 10AM till 2PM. I had taken my shirt off to get some sun and he must have assumed that I was on a mission to get some vitamin D. I do indeed like getting my vitamin D naturally and I also like not looking like a beached white whale when I visit Hawaii or the Caribbean. Hawaii But, please take note! I try very hard to limit my sun exposure, paying close attention to the length of time and the time of day that I walk around without a shirt on. I’m pretty white. To tan, I must expose myself very gradually to the sun, which works out great for vitamin D production. The usual recommendation is about half the time it takes for the skin to turn pink. For my skin, that’s about 20 to 30 minutes depending on time of day.

Living in Arizona, this whole “solar noon” thing intrigued me. Walking at high noon in Arizona, in August, is just plain crazy. It’s friggin’ hot! I told the guy that the amount of UV radiation reaching us during the day is somewhat of a bell curve so I was still getting my vitamin D even though it wasn’t even 9AM yet. That’s what my logical, scientific mind thought, anyway, and later I decided to see if I could verify that theory. I discovered the WillyWeather website that has the UV index for the Phoenix area, day by day, hour by hour. Lo and behold, it’s a bell curve!

My science served me well in this case, at least as far as the bell curve theory. But am I getting any vitamin D synthesized? Most sources that I checked suggested a balance between exposure and protection. It appears that a UV index around 3 is what will yield good vitamin D synthesis while minimizing the risk of skin damage and the formation of those dangerous radicals that could lead to skin cancer. I am pretty happy to discover all that. During these training walks we often start at 5AM. I will often take my shirt off around 7 to 7:30, if in an appropriate environment, and get covered back up by 9AM. This seemed intuitive to me and I feel more comfortable doing this now that I have done the research. The UV index in the Phoenix area hits 3 between 8AM and 9AM. Again, I trust in that bell curve and feel that even when the index is 2, I am synthesizing some vitamin D. Plus it feels good to have the morning breeze on my skin! We all live under the same sun and as long as we respect its power, we can all benefit from it.

Getting back to those bottles of 50,000 IU vitamin D2 on my shelf.. How long will it take for prescribers to catch up with the science and start ordering D3 for their patients? Both forms are very low cost and well tolerated. For some great guidance and solid information, visit the Vitamin D Council website. I encourage my pharmacist friends to spread the word so that we can get D3 onto that shelf where we have the D2 stacked now. To my physician and other prescriber friends, what are you waiting for?

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Boob News

I’m in the middle of training for the Susan G. Komen 3-Day Walk for breast cancer. I’ll be joining my wife and her team to walk 60 miles in 3 days in the Twin Cities (August 19-21). I’ve helped out the team in the past 8 years by running errands, fetching jackets, taking jackets away, bringing ice cold Diet Cokes or G2 and ferrying the team from day’s end to the hotel and back again in the morning. In that role I’ve been called “team bitch,” “walker stalker,” and last year a lady gave me my personal favorite, “underwire.”
You have to realize that there are hundreds of teams and thousands of walkers for these events and their team names often eschew normal political correctness with team names proudly flaunted, using every variation of slang for breasts from ta-ta’s to tits (including itty bitty titties), boobs and boobies, of course, hooters, second base, cupcakes, and many more. So pardon any lack of decorum on my part.

It’s no wonder then, that I am attuned to breasts and stories about breasts when I see them. Who am I kidding? I’ve been tuned into breasts since my first ex utero meal. Here are couple developments that I recently noticed:

I caught this headline in USA Today: “Why Millennials are Going Braless” and I just had to see what was going on (or coming off!). It seems that this generation of young women are opting for lighter, wireless “bralettes” of simply doing without. As a teenager in the 60’s, I recall stories of women burning their bras as a statement of liberation for women. For young men like myself, our solidarity in that cause may have been somewhat tainted by the desire to see nearly naked boobies parading around our neighborhoods. Right on, sister!
This new phenomenon of minimal breast support is even having an impact of sales at places like Victoria’s Secret, where bra sales are are sagging and its stock price is down 30% this year. With about 1/3 of their revenue traditionally coming from bra sales, that is no surprise. The Wonder Bra is on the way out in favor of the more natural style preferred by Millennials. Victoria’s Secret now offers bralettes that are very light, offering little support or padding but are stylish and meant to be exposed. Maybe sales will bounce back. Celebrities are leading the way as they do in most areas of fashion. It looks like my underwire nickname may be in jeopardy. Also, according to Plastic Surgery News there were 279,000 breast augmentations in 2015 and that is down 2% from the previous. For the record, I like ’em natural.

About half of US states have breast density notification laws. Now before you guys start running around hefting the boobs in your lives, this is actually medically important because high breast density is a risk factor for developing breast cancer. The problem is that there is huge variation in how mammogram density results are interpreted and/or obtained. The human reading the results is the primary cause of variation as different providers must be subjective in their finding. There are no clearly measurable results that can be shared in a uniform manner. Even different brands of mammography equipment will show differing degrees of tissue density. Of course, BMI, race and ethnicity are also factors. Finally, the amount of compression used on the breast during the procedure can result in a different appearance. Talk about having your tit caught in a wringer! Roughly 2 out of 5 women have dense breasts and would be considered for additional tests such as MRI or ultrasound. There is hope that computer models will bring some objectivity to the measurement of breast density. Until that happens keep doing your self exams and always discuss your options with your trusted doctor.

Support a 3-Day walker!

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Medical Food Gets Served

We do not dispense much medical food in the pharmacy where I work. It’s been limited in the past to products like Axona and we may have ordered in some Pulmocare too. Some folks might even consider products like Ultrase (pancreatic enzymes) to be a medical food. Others would add those special folate products like Cerefolin and Folgard to the list. Most of these have been covered by prescription insurance but I wonder if that will continue considering a recent FDA action: the final guidance reiterates FDA’s original premise that medical foods cannot bear the term “Rx only” because that term can only be used in the labeling of prescription drugs, and that medical foods should not bear an NDC number, which could cause the product’s labeling to be misleading. Of course, if these products are not prescription products, I expect many prescription plans will not cover them and if they bear no NDC number, pharmacies will have no easy way to bill them through normal Rx billing methods. The NDC is universally used as a drug identifier on pharmacy claims. Note that the recent FDA guidance is the final one, so now these specifications will become fully enforceable.

To be fair, I never understood why something like Folgard was Rx, other than to generate sales via insurance coverage. Here is what is in Folgard: 2000 IU vitamin D3, 800 mcg folic acid, 12 mg vitamin B6, 120 mcg vitamin B12. You can see that there is nothing there that makes you jump ump and say “Wow! That stuff should be prescription only!”

The FDA guidance says that Inborn Errors of Metabolism (IEM) could be managed by a medical food, so long as the specific IEM cannot be managed with modification of the normal diet alone. An example used is phenylketonuria, the impaired metabolism of phenylalanine. Interestingly, Lofenalac, an infant formula created by Mead Johnson, is considered the first commercially developed medical food brought and was brought to market in the late 1960s. Conversely,the FDA reasons that the galactosemia (an IEM of impaired galactose metabolism) is commonly managed by limiting intake of lactose and galactose.

All this is relatively new and will take some time to all shake out. My guess is that we will see fewer and fewer of these products covered by Rx insurance, whether Medicare or private. The sad part is that many patients could benefit from good medical foods that in many cases are superior to drug therapy or are, in fact, the only option to manage their IEM.

You can find an FAQ on the latest guidance on the FDA web site.

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My DNA Makes Me Wonder

A while back I send some spit into ancestry.com for a DNA analysis that would show my general genetic origins. Having heard speculation that we had some American Indian blood in our family tree, I was quite anxious to see if this was true. I have also researched my family tree using the resources on ancestry.com and other web sources, tracing my patriarchal line back to some of the earlier colonizers of Quebec. I was able to identify when some of my ancestors came from France to the areas around Quebec and Montreal. Much of this research is quite murky and found me brushing up on my French skills as I tried to decipher scans of birth, death, and wedding records that were written over 400 years ago in various styles of cursive and in French. Challenging to say the least!

2flagsin1
Anyhow, with information like what I found about some of my possible ancestors leading me to discover many liaisons with native Americans which gave rise to a mixed race dubbed “Metis,” I fully expected my DNA to show some native genetic trace. Here is an example of the stories that led me to that conclusion:

647 December 3: (I)-Medard Chouart Des Groseillier (1618-1696?) married Helene Martin, in Fort Quebec and settled down in Trois Rivieres; being the first wedding in several years (this is not true). Helene is the daughter of a river pilot, Abraham Martin, whose land would become known as the Plains of Abraham. Medard’s second marriage after the death of his first wife, is to (II)-Marguerite Hayet dit Radisson,a half sister of (II)-Pierre Esprit Radisson, Metis, (1632-1710). Pierre Radisson, at age 15, while out on a duck shoot, is captured by the Mohawks and taken to Lake Champlain. He is adopted by the tribe and became an Indian. He and a Algonquin escaped but were soon captured. The Algonquian is killed and (II)-Pierre Esprit Radisson, Metis (1632-1710) is tortured but rescued by his adoptive family. He later escaped to the Dutch Fort Orange near Albany, New York, worked as an interpreter for the Dutch, and then made his way back to Trois Rivieres- all before turning 21 years old. (see Radisson 1631)

1649 January 19: A female of age 15 or 16 is hung at Quebek (Quebec) for theft and Monsieur (I)-Abraham Martin, dit I’ecossois (1589-1664) a Scotsman is accused of violating (raping) her. Some suggest a sixteen year-old girl in Quebec, sentenced to death for theft, escaped death by acting as her own executioner. Still others suggest the executioner is a pardoned criminal and the girl is hung.

1649 February 15: Kebec, (I)-Abraham Martin dit L’Ecossais (1589-1664) is imprisoned on a scandalous charge concerning a girl 15-16 years old who was executed this year for theft. It is said this old pig Abraham had debauched the girl. This could be the reason the birth and marriage records are not retained, the Jesuits likely cleared the files?

from New France: Quebec Cultural Roots by D. Garneau

Apparently the Jesuits were some of the few people reading and writing and thus controlled what records were kept and there was a bit of sanitizing going on. Also plenty of shenanigans!

Here too is a record of showing the mingling of New World and Old World DNA:

1638 May 22: Kebec, marriage (I)-Etienne Racine, b-1607 to (II)-Marguerite Martin, Metis (1624-1679) daughter (I)-Abraham Martin dit L’Ecossais (1589-1664) and Huron savagesse and/or Marguerite Langlois, Metis b-1611?, see 1624: It was on May 22, 1638 that, Father Nicolas Adam fulfilled his parish duties at Quebec. He blessed the union of (I)-Etienne Racine and (II)-Marguerite Martin, Metis, b-1624, now fourteen years old. Olivier Tardif/LeTardif and Guillaume Couillard were present. Promise of marriage was made November 16, 1637.

And then I get my DNA results back and it shows 100% European ancestry! Here’s what it shows:
Europe 100%
Ireland 28%
Europe West 19%
Italy/Greece 17%
Iberian Peninsula 15%
Scandinavia 12%
Great Britain 8%
Trace Regions 1%

Everything that I learned first-hand from my family elders and everything that I learned from my research on-line makes me doubt the accuracy of these results. Everybody that I met in the family had very strong French roots. So now I wonder if a different agency might use different technology for their DNA testing and I am tempted to spend a few bucks to get a second opinion.

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Hygeia Acceptance Speech (annotated)

Just one day before starting vacation I was honored to receive the Bowl of Hygeia Award for Arizona. I knew I would give a little speech so here is what I wrote. I’m not much for reading from a script, as anyone who has been to one of my talks knows. So I’ll try to give you some of the ad-libs as I remember them (in parentheses) and some mental background (italics).

Hello Arizona pharmacy! I’ll be brief. Action speaks louder than words. (This went a little wordier as I commented on my wife’s comprehensive introduction and recount of my service and good deeds) (After hearing her speech, I was taken by how many of my endeavors involved sports and the Susan G Komen 3-Day. I almost commented that “wow, after hearing Kathy talk about me, you must think I’m all about balls and boobs!” but I held my tongue)

This is truly an honor and I am humbled to join the ranks of so many wonderful pharmacists, many of whom are here today. I have to give thanks, starting with my family, especially my wonderful wife Kathy, who is already a Hygeian. (I was paraphrasing by this point and I don’t think I used the term Hygeian to describe Kathy) I love you always, babe. To the many pharmacists and technicians that have been a part of my career, names like Savage, Wastchak, and Kristal that many of you may recall fondly. To my Fry’s family (Paul says we now have 8 Hygeia winners), to ASU, (kept out the part where I was going to say that my stint at ASU was like a 12 year rotation with a focus on sex, drugs, and rock & roll because I didn’t want to make the other schools jealous.) UConn ( I gave a nod to Jim and Maria, fellow alum), and the AZPA ( gave a plug here to encourage everyone to find a new member!). To the U of A and Midwestern for letting me precept their students, keeping my brain agile and alert. To my amazing mother, whose values and unconditional love started it all and kept me going through thick and thin. (Got a little emotional here and rambled something about living on rice and veggies while working my way through school) (that may have been a little cheesy, but true, and it got me back on track).

Being a part of the Mesa Leadership program was a terrific opportunity to learn about my community from the inside out, giving me a chance to meet our leaders and learn where I could make a difference. This diverse (I told them awkwardly just how diverse) group had many sessions where we worked out solutions to problems through respectful debate and a desire to do some good. In this election year, I will demand the same attitude from my elected leaders.

I would encourage more pharmacists to take part in these types of civic programs which are a great way to broaden your horizons beyond pharmacy and have an impact on your community. (paraphrased, then I glanced down to get this next part right…)

Our national political environment has developed into a shallow spectacle, where demagoguery is acceptable (and unfortunately, effective), corporations are people, and money is free speech. Don’t let yourself be drowned out. Participate beyond voting. We elect people to represent us and to work together for the common good. Insist on that. (I added that I would like to throw them all in a room and lock them in until solutions were found) (My first draft was harsher and contained the phrase “the bastards” so I was pretty smart to edit it to something more appropriate to the occasion)

Thank you all for being a part of this grand adventure and keep pushing the envelope. Get out there and do more good! Thank you all! (or something pretty close to that)

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