House of Cards

The phrase house of cards refers to an institution whose very infrastructure is so fragile and unstable that they are prone to collapse at any moment.

That's not what I'm talking about.

I'm talking about your local drugstore. Walk into any modern drug superstore and you're likely to find at least one or two aisles dedicated to greeting cards. Whether it's American Greetings or Hallmark, or some other offbrand of expensive, colorful cardboard, the greeting card business would appear to be the primary function of your local apothecary.



That's not what I'm talking about either.

Here's a fun little exercise. Walk to the back of your local drugstore, grab a seat in the waiting area, kick up your heels, relax, and enjoy the chaos. What was once a fairly quiet and serene place, the back of the pharmacy counter, is most likely going to be more busy than New York's Grand Central station at rush hour. The pharmacist, who used to work solo, is now swarmed by a flock of minions, who busily rush around, to and fro, processing paperwork.


I think I know why Martin Mull's character, Russell the pharmacist, has a substance abuse problem. I know that I would have one if I had put in long hours in such a crazy environment.



The pharmacy counter changed from its serene origins into a crazy place that it now is when prescription drug coverage came into vogue. Where once the pharmacist only had to concern his or herself without the act of filling prescriptions, they were forced into becoming insurance clerks, checking coverage and formularies for every new prescription. They were forced to take on added help in order for them to complete this grinding task. This mirrored the transformation of the physician's office several decades before when they had to start processing insurance forms along with providing health care for their patients. In case you haven't noticed, the modern medical office no longer resembles the Norman Rockwell ideal.



" You want me to check the heartbeat of your doll, kid? Take a hike!"



Recently, the game behind the pharmacy counter has been turned up to its now frenzied level. This is due entirely to the advanced of the co-pay prescription card. These cards are now gleefully handed out by most major pharmaceutical companies to help combat high co-pays imposed by prescription insurance companies. The problem seems to be that none of these cards actually follow a standard way of processing. Worker bees at the pharmacy must cajole, swipe, and telephone the different entities who process these cards on behalf of of the pharmaceutical company. To add insult to injury, if the patient fails to hand the pharmacy clerk there prescription card upfront (as most of them do), the clerk is then forced to scrap the entire transaction and start all over again. I personally experienced this when I used such a card while filling a recent prescription. And yes, I was the douche bag who forgot to give them the card before they processed my claim. Long story short, it took a over one half an hour for me to pick up my overpriced prescription.

So what does this mean to the healthcare consumer?

Well it should be obvious to anyone that the added people working at the pharmacy counter don't work for free. In addition to their salaries, there are benefits to be paid, 401(k)s to be financed, FICA taxes to be filed, and a whole host of associated expenses. And ultimately, the healthcare consumer will be footing the bill for these added employees.

After witnessing the chaos at my local CVS firsthand, I realized what a tenuous state that my local pharmacy was in. The anarchy behind the pharmacy counter made it appear that the whole shebang was about to collapse.

So maybe your local pharmacy does follow the true definition of " House of Cards" after all.

So, what's the solution to this impending disaster? I, for one, believe in" out-of-the-box thinking" in order to solve these new world problems. Now is not the time to be coloring inside the lines.

So, I would propose that we start staffing our pharmacies with cheap labor. And in the United States, this means either illegal immigrants or prisoners. Since the news media seems to be against all forms of illegal immigrant labor, I think it's best that we embrace the incarcerated labor force. Prisoners work even cheaper than migrant farmworkers, and we certainly have more of them. This is not a perfect plan. For instance, you're going to have to drive to your local county clink instead of your neighborhood Walgreens to pick up your overpriced Boner pills. But such is the price of progress.



" Mr. Green, your prescription is ready. Please see Mr. Tiny. He is the one with all the homemade tattoos wearing the red bandanna. And, if I were you, I wouldn't bring up the fact that you have a co-pay card and that he's going to have to reprocess your entire order. When he was raping me in the shower this morning, he mentioned that he's fashioned homemade shiv out of a plastic beach pail shovel that he stole from aisle three."

when you think about it, they've been using the scared straight approach to keep kids off of illicit drugs. Perhaps the same scared straight approach will work to help break Americans from their addiction to overpriced pharmaceuticals.


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Highlights

For me, as a youngster, the best part of going to the Doctor was reading those “Highlights” magazines in the waiting room. They usually featured great picture puzzles that would keep me entertained and distracted until I was called back into an exam room where I would wait, cold and naked, to get a needle jabbed in my butt and a thermometer rammed into an orafice that was designed to be an exit and not an entry.


One of my favorite picture puzzles was where they would present two pictures, side by side, and the reader was asked to determine ‘what is the difference between these two pictures’. For the sake of recreating that medical office fun, I’ve decided to recreate that little game, right here in my blog.

Are you ready for some fun? I hope so!

Here we go:







Picture ‘A’ is a photo of Athlete’s foot vream that my wife purchased at Walmart.

Picture ‘B’ is a tube of Athelete’s Foot Cream that I bought at the local CVS.

So, my eagle-eyed viewers, what are the differences between these two photos?

Give up? Well, just turn your computer monitor upside down and read the fine print bebeath the photos – or just read on.

Difference 1: The Walmart tube is smaller than the CVS tube. In fact, the CVS tube contains almost 3 times as much cream as the Walmart tube.

Difference 2: The WalMart cream says to use it once a day for 4 weeks. The CVS cream says to use it twice a day for 4 weeks.

Difference 3: Picture ‘A’ is a GENERIC drug – basically the non-prescription version of Lotramin. Picture ‘B’ is a name brand prescription drug..

Picture ‘A’ cost my wife 77 cents for the tube. So, for the same amount of cream as Picture ‘B’. It costs a whopping $ 2.42. I don’t really know what Picture ‘B’ costs since I have a prescription plan. However, a Google search shows that I can but the same tube of cream from a website called ‘Cheapo Drugs’ for $ 821.25.

Aren’t these side-by-side puzzles fun?

Both creams have a lot in common as well. Both have a proven track record of curing athelete’s foot. Both do it in about the same amount of time (although the prescription version has to be applied twice a day vs. Once a day for the Walmart cream. But there are more differences between the 2 products that escape the eye.

For instance, Walmart never buys my Podiatrist lunch, or gives him fancy tote bags. They never visit him at his office to extol the virtues of their 77 cent tube of ceam, or scold him for not writing enough prescriptions for their cream.

Oh yes – I just thought up another difference. That tube of Walmart cream costs almost the same amount of money as a cup of McDonalds coffee (and my local Walmart has a Mc Donalds right inside their store. This means that if you were down to your last dollar, you can choose between being sleepy or having itchy feet).

On the other hand, the CVS prescription cream costs more than I paid for my first car.




But, to be fair, I bought that car way back in 1977, and you have to allow for inflation.

I blame Obama for this runaway inflation – don’t you?






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Lazy Days

Yeah, I know. I haven’t posted to my blog lately. It’s a real shame, too. My blog just had it’s 20,000th visitor, and I still keep getting a lot of traffic in spite of my lack of new content.

It’s really not my fault – the lack of posting is due to a newly diagnosed medical condition. It seems I suffer from something called ‘Chronic Laziness Disorder’, or CLD. You say you never heard of CLD? Don’t worry – as soon as Big Pharm comes up with a drug for it, you’ll be seeing commercials for it on ‘The Price is Right’. Rumor has it that Pfizer is partnering with Starbucks and developing a cup of Joe that has twice the caffeine that a normal cup of their ‘over the counter’ coffee has. It will be available only by prescription and cost $25.00 a cup. Leave it to the American Pharmaceutical industry to make a cup of Starbucks even more expensive.



Pfizer is also planning to release a caffeine-enhanced prescription Frapuccino for the summer months that has twice the caffeine and sugar as the regualr stuff. In fact, it will have so much sugar in a cup that it will send many people into a diabetic coma. This is seen by Pfizer as a great cross-market for it’s line of diabetes medicine and glucose meters. Too bad that the prescription Frapuccino will be so expensive that most prescription plans will label it a ‘tier one’ drug with a ludicrously high co-pay. Fortunately, Duncan Donuts will soon offer it’s own prescription ‘Coolata’ at a much lower cost, so your med carriers formulary will allow you to get this drink for only a$20 copay so long as your MB (or Medical Barista) didn’t check off the ‘no substitution’ box on your prescription.

Until these new drugs for my CLD are released, I will have to suffer (and nap) in silence.

Although prescription coffee may sound ludicrous, the idea really isn't that far-fetched. After all, Big Pharm has been offering ‘Prescription Strength’ versions of over-the-counter meds like aspirin, tylenol, and various antacids for years now. And we’ve been blindly paying outrageous fees for them for years, instead of buying the over-the-counter versions at Wal-Mart and doubling up on the dose.

My Podiatrist recently gave me a prescription for Athlete’s Foot cream that sells for close to $300 a tube. Now, my Athlete’s Foot isn’t that bad – in fact, I didn’t even know I had it. (When I was in High School, I never had the makings of a Varsity Athlete - at least that’s what my Uncle Junior used to say).
So why don’t I just buy a $2.00 tube of over-the-counter cream at Wal-Mart? Good question. Luckily, my prescription came with a special copay card that allows me to pay a zero copay for the cream. This way, I can get ‘the good stuff’, and not have to worry about the price – until I’m hit with my new health insurance premiums next year. Like most Americans, I’ll probably follow the advice of ‘The Yardbirds’ and “Live for Today”. In fact, I think that this just might be the next Classic Rock song that’s used in a television commercial – Merck – I’m looking in your direction.


In case you were wondering, this whole diatribe was provoked by a link my buddy PG posted on his Facebook page. What first struck me as funny seemed less farfetched the nore that I watched it.

I hope you will enjoy it as much as I did.



Now, let me get back to my nap.....




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Warning Labels

Since I was on the topic of all those scary FDA-mandated warnings that are the end of almost every prescription drug commercial on TV, I got to thinking “why do they bother?” After all, most of us have become so numb to this little medical horror stories that we automatically tune them out. Besides, shouldn’t be warned about harmful side effects by the doctor writing the prescription or the pharmacist dispensing the medication?

Don’t get me wrong – I think that commercials for prescription medications should include stern warnings – but I think that these warnings should be more along these lines:



WARNING: Accountants have determined that use of this medication can cause irreparable harm to your bank account. One month’s supply costs more than your car payment. If you have prescription coverage, please realize that drugs like these are the reason why your premium id going up by 20% next year.




WARNING: This drug really isn’t tested as well as it should be. We’ve cut as many corners as possible in order to get it to market before the competition releases their overpriced pill. As a result, we’re probably going to discover some unforeseen side effects somewhere down the road. The only reason why we’re telling you about the bad side effects that we currently know about is because the FDA is making us do it. Besides, our lawyers tell us that this may prevent you from suing us in the future when your hair falls out and you lose your senses of taste and smell.




WARNING: Even though this drug was designed, tested, and manufactured in the USA, it sells for a lot less in every other country in the world. That’s because foreign governments set prices and limit what we can charge for it. Bastards.

That’s what we love about America. Here, we can pay lobbyists tons of money to ensure that your government won’t let this price fixing happen here. Our lobbyists even got your government to pass laws that prevent you from buying these drugs cheaper from another country over the internet. Our lobbyists are very good. They are also very expensive, but that’s OK – we just pass the costs on to you.




WARNING: Only one person in a thousand actually has the illness that this drug is for. You might ask yourself “How can they afford to advertise it on national TV?” It’s really quite simple – we just pass the costs on to the people who actually need the drug and are forced to pay the outrageous price tag..




WARNING: This drug doesn’t treat your condition any better than that $4.00 Generic medication. The generic medication is well tested and we know that it won’t have any unforeseen side effects. The only thing that’s wrong with the generic drug is that its patent has expired, and we can’t overcharge for it anymore.

We’re going to lead you to believe that the generic drug is somehow lower quality. The truth is, we make it on the same factory as the new drug that we’re trying to sell you.




WARNING: The statistical evidence that we’re presenting about the superiority of this drug are really questionable. Statistics are easy to manipulate. We use them to lie to you.




WARNING: Our profit margins are astronomical. We take a few pennies worth of chemicals and sell them for hundreds of dollars. We do have high costs, but they have nothing to do with the manufacturing of this drug. Take this TV commercial, for instance. It costs us many thousands of dollars each time we air it. And we air it many times a day all over the country. It’s OK, though, because we’re passing the costs on to you.



WARNING: You can’t buy this drug on your own. You can’t decide that this is the right drug for you. That’s really your Doctor’s decision. So why do we spend millions advertising it directly to consumers? Good question.




WARNING: This might not be the best drug for you. However, we’er going to bribe your Doctor so that he or she will prescribe it. We do this with free lunches, theatre and sporting tickets, special all expenses paid travel junkets, and free pens , post it notes, and other office supply goodies. Most Doctors never have to spend a penny for pens and note pads. Most Doctors never have to buy lunch for themselves or their staff either. We buy this for them, and then we pass the cost on to you.



WARNING: This drug is really expensive. Doctors don’t really care what these drug cost, because we give them all they could use for free. Same goes for their staff, family and friends.




WARNING: This drug is really expensive. Your insurance company doesn’t want to pay for it so they’re going to charge you a really high co-pay in order to discourage you from buying it. That’s OK, though, because we’re going to give you a special discount card so you don’t have to pay a lot of money out of pocket. You’ll just end up paying for it next year when your insurance premiums skyrocket, but that’s OK too because we know that you’ll blame your insurance company and not us.



WARNING: This prescription pain killer doesn’t cost us any more to manufacture than that bottle of generic pain killer that you bought at Walmart last week. Doesn’t even work much better, either. But we can charge 100 times more for it. Isn’t that awesome?


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60 Minutes

I watched 60 Minutes last night - that long running TV News magazine renowned for its hard-hitting coverage of current events and trends.

There was a fascinating story of Dr. Dan Ecklund of Equator who was selling Stem Cell Treatments over the internet for $5,000 a shot. Dr. Ecklund was claiming that his stem cell treatments could treat a myriad of conditions, including cerebral palsy.

They managed to lure the Doctor into a Florida hotel room, where they ambushed him with a surprise hidden camera interview.

Dr. Ecklund did the most amazing thing - instead of turning on his heel and making a quick exit, he actually stayed and gave them a pretty good interview. This is remarkable because the Doctor could easily have been arrested for selling stem cells in the US. Selling stem cells in the US for an unapproved treatment is a felony.
Not that stem cells are harmful in any way - it's just that the government wants to make sure that we don't get taken by some nefarious trickster. Thank goodness for that.

The 60 Minutes reporter accused Dr. Ecklund of being a charlatan selling false hope to desperate people. They pointed out that there were no articles in any US Medical journal that supported his claims. Dr. Ecklund rebutted that there were many articles in European journals that did support his claims. (As if they know anything about medicine in Europe - if medicine in Europe was any good, why do they have to give it away?)

Throughout the interview, they intermixed comments from Dr. Kurzberg, a medical researcher at Duke University who disputed almost everything that Dr. Ecklund claimed.


60 Minutes also pointed out that Dr. Ecklund had lost his license to practice medicine in the US because he had sexual contact with an underage female patient. This was a pertinent point to their argument against Stem Cell treatments.

The Dr. Ecklund went so far as to claim that most stem cell research in this country is being suppressed by the Pharmaceutical industry - as if the Pharmaceutical industry has any influence in America! What nerve!

60 minutes also made a point of mocking Dr. Ecklund's 'state of the art' Ecuadorian laboratory. Even the poorest pharmaceutical company in the US would be embarrassed by such a shoddy lab!

I am so glad that venerable news organizations are increasing public awarness about the evils od stem cell treatment. Recently, my pal's dog had some stem cell injections to treat hip Dysplasia. It worked so well that the dog is back to normal activity. But who in their right mind would want to receive the same medical treatment that they use on ANIMALS? Even if it potentially could bringsome relief to people suffering from horrible conditions like cerebral palsy? Thank God that they force Doctors like Dan Ecklund to practice healing in some third world Banana Republic, where there is no FDA (or pharmaceutical industry)!

Finally, Dr. Ecklund had had enough grilling from the 60 Minutes reporter, and he got up and left the interview. 60 Minutes then cut to a commercial.

Turns out that the entire segment was brought to us courtesy of Lipitor. A little internet research shows that Duke University gets billions in donations from the US Pharmaceutical industry. Reading the 60 Minutes web site this morning, I was amazed by the number of people commenting on the segment and extolling the effectiveness of Stem Cell research for a myriad of conditions, including Cerebral Palsy.

Those of us suffering from diseases or conditions that could potentially be reversed or cured by innocuous stem cells will just have to wait for the proper research to be completed before we can receive stem cell therapy. Even once all the medical evidence is in, it's still going to take a VERY long time before some lawyer is able to figure out how to patent stem cells. While stem cell treatments at $5,000 a shot might sound expensive, they're actually a lot less expensive than a lifelong course of pharmaceuticals that don't actually cure anything. Stem cells have a lousy business model.


Normally, this might raise a few eyebrows regarding the voracity of the 60 Minutes interview. But, hey, as they pointed out, Dr. Ecklund is a child molester! Who would want what he's selling?



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The New American Idol

And so it begins again. The cycle continues. And I’m tired of it.

In a couple of weeks, the next season of ‘American Idol’ will begin its five month assault on our TV screens, monopolizing the prime time schedule and clogging up our DVR’s. It will once again ask the question “Who will be the next American Idol?”, and once again, I will answer “I don’t care”.

The well tested formula will be repeated. The first month of shows will undoubtedly be the auditions, where people who can carry a tune will be intermixed with clips of those who can’t sing at all. Usually, this second group will consist of people who are living in denial of their lack of talent, and many of them will curse out the judges who brought this fact to light in front of a national audience. One judge will have their own moments of insanity (I’m looking at you, Steven Tyler). Ho-hum. We’ve all seen this before.

There will be stories of contestants who have overcome some adversity in their lives to make it into the next phase of the competition. There will also be a least one contestant who didn’t make it last year and who is now back for a second try at stardom. How droll.

You can also bet that at least one contestant will have an illegitimate child who they ‘miss terribly’. Another contestant will have had a recent death in their family, and they’ll be dedicating their performances to the memory of the dearly departed. Wake me when it’s over.

There’s going to be special guest mentors who will have the contestants perform songs that are entirely unsuited to their vocal talent, and judges who criticize these contestants for their poor song choice. Randy Jackson will call everyone ‘dog’, and question the way that some people are dressed. (remember what they say about people living in glass houses, Randy)



Finally, we’ll have many, many moments of artificial drama, fueled by the talent less Ryan Seacrest, as well as plenty of adolescent little girls flashing placards that were handed out by the show’s producers. I think that I’m going to be ill.

If last season is any indication (and I think that it was), American Idol has jumped the proverbial shark. Last season ended in what amounted to a Country-Western Karaoke contest, and most of America was bored to tears. I know that I was.




At least Simon Cowell had the good sense to leave this fiasco. He pulled a Don Mattingly, and tendered his resignation before he embarrassed himself too badly.

Mr. Cowell just finished the first season of his new show, the X-Factor, which was marginally better than American Idol, but in the end was just another re-warmed rehash of the genre. I give that show another year or so until it degrades into the tasteless goo that American Idol has become.

Let’s face it – lots of folks can carry a tune. Many of them have good vocal instruments that can be fine tuned by professionals into something that is pleasant to listen to. And some of those folks also have a good stage presence, but so what? The lounges of Las Vegas are chock full of such people, and we really don’t need any more of them.



What we need is a new genre of talent show – one that will help discover the next rare talent – and I think that I have found ‘just what the Doctor ordered”.

I call the show ‘The FDA Factor’ (it’s a working title).

I came up with this idea when I realized that the most truly gifted vocalists on the planet are those that you hear at the end of every pharmaceutical advertisement on TV. They’re the disembodied voices that list off all of the dire side effects of whatever pharmaceutical is being pimped in the commercial, and they do so in the most pleasant way possible. This is no easy task.

These voices must sound friendly yet authoritative at the same time. Most importantly, they need to make the horrible side effects of each drug sound non-scary. This is REAL talent. Usually, the mere mentioning of these horrifying effects would make us lose our lunch. They usually sound like something out of a Stephen King novel. “Sudden death”, “Heart Attack”, “Stroke”, “Birth Defects”, “Cancer”, “uncontrollable Muscle Movements”, “Loss of Vision and Hearing” – these are just some of the medical horrors we all hear several times a day being rattled off at the end of almost every drug commercial. Earlier today I heard a commercial for a drug that listed “Uncontrolled Bleeding” as its side effect. Another one talked about a "Fatal Brain Condition". Yikes!

So why aren’t we all freaked out by the mere mentioning of these terrible things? It’s got to be ‘The Voice’. The calm, cool, soothing tones that help make the unthinkable seem downright palatable. Now that’s REAL rare talent.



I know that Scotty McCreery couldn’t do this in that twangy baritone (unless the side effect was an 'Achey-Breaky Heart'). Forget about Kelly Clarkson too. Fantasia and Adam Lambert would probably have the opposite effect and make the nasty side effects sound even worse than they are (if that’s even possible).



No, I think that we all can agree that it takes a one in a million type voice to pull this magic act off.

Everything else about my new show would loosely follow the trusty, rusty American Idol formula. Instead of Ryan Seacrest, actor Hugh Laurie could be the host. The winner would get a million dollar deal making commercials for some multinational pharmaceutical company. The judges could be a panel of former pharmaceutical reps. Instead of Coca-Cola, the contest could be sponsored by Panera’s (the unofficial supplier of free Doctor’s lunches in the pharmaceutical industry). Instead of the Kodak Theater, the final show could take place at the AAFP National Convention. The show practically writes itself.



Aside from the entertainment value, the show would provide a much needed service for industry as well. With the continuous release of poorly tested, overpriced pharmaceuticals being unleashed on the American public, Big Pharm is going to need all the spokesmen and women to convince us that that new acne drug is worth risking that brain tumor for.

Hey, Fox Network, let’s cut a deal. Call Me! I’m in the book.



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