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Pepin's Pharmaceutical Prattle for 01-05-2009


 Quote of the day:  I'm living so far beyond my income that we may

                    almost be said to be living apart.

                       e e cummings (1894 - 1962)


 Good Morning!


e e cummings had a very economic writing style. He neither used capital letters nor did he invest in any punctuation. This made it more difficult to read his material but it did set him apart. As stingy as he was with periods, quotes, and commas he made up for with his extravagant lifestyle.

     Consumer spending has been out of control with the average yearly savings in the negative numbers. The majority of us were spending MORE than we made every year. Debt mounted. This Christmas season, however, saw a decrease in consumer spending. With the economy the way it is more people are beginning to spend less on many things. Could it be that many have learned the "B" word? Budgets are another way of saying PLAN. For a plan to work you have to have a GOAL. If you do not have a destination in mind then how will you know when you have arrived?

      Many people are cutting back on many things in general but most do not have a plan. Maslow's levels of needs start with physiologic needs: air, food, water, and a relatively constant body temperature. Next are safety needs then come Love, affection, and belongings. Self esteem and the need for self actualization round out the list. Where should prescription drugs fit in the cascade?  Some patients are indiscriminately failing to fill prescriptions. Some drugs such as insulin and cardiac drugs should fit into the first level... hands down. Some drugs, such as Viagra, may fall lower on the scale. Pharmacists and physicians should educate patients so that they make these choices with full knowledge. Patients have to be told which drugs are ESSENTIAL or the results could be lethal. Insisting that patients take their "blood thinner" may fall on deaf ears as most patients doesn't care how thick their blood is. Education as to the consequence, formation of blood clots which can cause heart attacks and strokes may be more important. The GOAL of therapy has to be explained or the economic choices made may take away the physiological health that we all value at our core. Consider this a suggestion as a new year's resolution!  Re-established patient education as a GOAL for 2009.

 Have a GREAT week!



ps. Best answer this week to the question "How are you?" was "I'm AMAZINGLY STUPENDOUS"

pps. Please note that some of the links may not be up for very long and that

     you should capture or print anything that you may wish to keep.



1) Last FDA drug approval of 2008

Degarelix was approved for use in patients with advanced prostate cancer. Reduced testosterone levels to those seen after surgical castration. Expect to see this drug used off label in sexual predators. (Just a prediction… I could be wrong) The drug has not been given a trade name yet… my vote is Deralix (or Deralict).


2) Warfarin dosing: less change is more

Optimal warfarin dosing appears to come from fewer changes in daily dose. It is easy to follow INRs but to overcompensate, like over-steering a car. Better therapy was achieved when changes were made to dosing when the INR was below 1.8 or above 3.2 and left alone in between.


3) Ever wonder how to choose a nursing home?

Health and Human Services has a 4-step approach to assure you make the best choice of a nursing home for yourself or a loved one. Just like the movies nursing homes are under a 5-star rating system. You can download the whole shebang at

  (Are you listening kids?)


4) Antibiotics BEFORE infections?

This flies in the face of what we have been told for years about the use of antibiotics, but then again it was a Dutch study and the Dutch DO have a reputation for rebellion. The study was done in intensive care units in the Netherlands and involved the use of oral and IV antibiotics prior to signs of infection. A reduction in mortality of between 11% and 13% was seen. “Bug” resistance to antibiotic has yet to be assessed.


5) High insulin levels linked to breast cancer

Women who had higher levels of insulin circulating in their blood streams were more likely to develop breast cancer. Obesity has been linked to breast cancer for years and this might be the reason. One more reason to keep those New Year’s diet resolutions… fight fat and cancer!


6) Racial differences in EPO requirements

It appears that black patients require more erythropoietin (EPO) than Caucasians. A 12% increased demand for EPO to maintain similar hemoglobin levels ads a significant expense to this regimen. There may have to be a federal adjustment to daily reimbursement for care based on race.


7) The ABCs of drug advertizing

Using this simple guide you should be able to classify ads into 3 basic types: 1) Help seeking (general disease state awareness) 2) Reminder ad  3) Product claim ad (the most complicated). See the site for more.






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Disclaimer: "Pepin's Pharmaceutical Prattle" (AKA "The Prattle") is the property of PHARMWORKS, LLC and Steven M. Pepin, Pharm. D, BCPS. The opinions expressed are those of the bald-headed author. To start or stop any drug without the advice and supervision of your physician would be stupid. So don't do anything based upon what you read here without professional advice.  To be added to or removed from the distribution list please e-mail your request to . All insightful comments from readers are thoughtfully considered (the rest are callously discarded). Copyright 1998-2009 PHARMWORKS,LLC all rights reserved.

Copyright 1998-2009 PHARMWORKS, LLC all rights reserved