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Pepin's Pharmaceutical Prattle for 03-02-2009

 Quote of the day: 

     Nothing in all the world is more dangerous

     than sincere ignorance and conscientious stupidity.

      Martin Luther King Jr. (1929 - 1968),Strength to Love, 1963

Good Morning!

The dumbest thing I ever did…

If you want to hold someone’s attention you can either talk about the other person’s favorite subject (themselves) or tell them about the stupidest thing you ever did. This medium is not conducive to the former so I will resort to the latter.

          I was working as a second cook on the Empire Builder run between Chicago and Seattle for Amtrak one summer (my freshman year in college). Instead of being on the road 5 days and resting for 5 days I would try to work as many runs as I could in order to make enough money to stay in school. My uniform consisted of black and white houndstooth pants, a white cooks coat, and a pointed paper hat. On one trip, instead of laying over until the next day I was supposed to take the place of my counterpart from the previous day’s run because he became ill. As we approached Chicago I had to take his place on the train coming out of Chicago. My suitcase was all packed but the dinning car was exceptionally busy so I stayed in the kitchen until we arrived at the little town at which I was to de-train. As we pulled into the station I stuffed my 14 inch carving knife, 12 inch bread knife, a paring knife and a two tined fork upon which I could have held a 20 pound turkey into an old pillowcase which I used for carrying the tools of the trade. Before I could assemble everything and run down the stairs, I found that the conductor had already closed the steps. I ran through the club car and found the conductor who dropped the steps on the now moving train. This all took awhile so the train was rapidly gaining momentum. The conductor did not know what I had in the pillowcase and suggested that I jump. Not being one to question the logic, I fabricated a way that this would work. As I jumped I would start running in the air before I hit the ground. In this manner, I fantasized, I would be able to stay on my feet (just like in the cartoons).

I had grossly underestimated the speed of the train and my ability to run that fast. My left foot hit first and the leg crumpled. Next my right knee hit the rocks and gravel holding the railroad ties in place as I began the first of two summersaults; my suitcase (not Sampsonite) landed on its corner and burst into a billow of underwear and socks, and, through the grace of God who cares for the terminally stupid, my pillowcase went flying from my hand and landed behind me instead of lacerating my liver or other vital organs. Once my dust had settled and the train passed I had to gather my belongings into my broken suitcase and limp back to the platform at the station in my soiled jacket, clown pants, and torn paper hat to the amusement of the passengers who had seen “crazy boy” jump from a moving train. I found out later that the conductor could have radioed to the engineer to put me off at the next station so I could have caught the outbound at a different station. I made a quick (but wrong) decision in a time sensitive situation without thinking it through.

As crazy-stupid as my actions then were I recently came upon something that makes this pale by comparison. Someone is proposing that, in the face of our present (time-sensitive) economic woes. taxes be raised on businesses, that price controls be put on prescription medications, and that capital gains taxes be hiked. I suggest that he read Aesop’s Fable about the goose that laid the golden eggs. What we need are more jobs (the eggs) and by his “redistribution” policies he is cutting off the heads of businesses that create jobs (the goose). And to think that he and I both have something in common… Chicago and fast-stupid mistakes.

Have a GREAT (and un-stupid) week!



ps. Best answer this week to the question "How are you?" was "I'm gettin' by... one day at a time."

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) Drug turns the blood to acid

OK… that was a bit intense but the FDA has warned that zonisamide (an anticonvulsant) can cause metabolic acidosis. Younger patients appear to be affected more frequently. Periodic measurement of serum bicarbonate, even in asymptomatic patients, is recommended.


2) The incredible shrinking planet

FDA has called the visuals in an AVODART commercial where a large planet (signifying an enlarged prostate) is replaced with a smaller planet. Misleading claims also appear in the ad. FDA was on its toes on this one. Now if someone could do something about that annoying NASONEX bee…


3) Obama rocks Euro drug stocks

By targeting high priced Euro based drugs for lower Medicare spending our new emperor cause euro drug stock to tumble. That’s right folks… he called for price controls. Isn’t it heartwarming to know that he can influence markets on both sides of the pond?


4) Darvon ban sought

AN FDA advisory committee had recommended that all Darvon (propoxyphene) products be removed from the market. It has been on a list of drugs that are relatively contraindicated in the elderly but this takes it a step further. Some deaths have been reported with its use but a causal relationship in a large number of cases lack conclusive evidence. Rightly or wrongly, after nearly 50 years of use, this one appears on its way out.


5) Legal eagles look into Seroquel data selection

Seroquel risks appear to have been downsized as the manufacturer hand picked the data to be evaluated. Academically dishonest at best and corporately punishable at worst. Drug may also be less effective than its cousin, Haldol.


6) Bad advice from pharmacists?

“My mother 68 year old mother has difficulty with speech and had left sided weakness … should I take her to the hospital, call for an ambulance, consult her primary care doctor or just wait to see if her symptoms resolve?” What would you say? The right answer was call 911 for an ambulance. When these stroke symptoms were described over the phone to 71 unwitting pharmacies 4 of 5 did not suggest immediate emergency services. The really scary thing is that 5 of the responses were made by technicians and one by a pharmacy student. (Make sure you tell your entire staff who is to respond to requests for medical/pharmaceutical advice). … I wonder if the pharmacy student got it right...


7) Don’t hold the MAYO

MAYO CLINIC researchers show lower morbidity and mortality for patients taking a statin at the time of a stroke than those who were not taking the cholesterol lowering drugs. Results did not depend upon the cholesterol levels achieved so another mechanism may be responsible for the protection.







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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