ppp 06-23-08

Quote of the day: Life engenders life.

Energy creates energy.

It is by spending oneself that one becomes rich.

Sarah Bernhardt (1844 - 1923)

Did you know that “pure” alcohol contains water? Alcohol can be “Dried” to 100% using special chemicals but will suck water from the air when exposed to room air. When burned ethanol produces energy C₂H₅OH(g) + 3 O₂(g) → 2 CO₂(g) + 3 H₂O(l) (ΔH_r = −1409 kJ/mol) For the math impaired this represents 84,600 BTU/gallon. Gasoline does not naturally contain any water but is a blend of various petroleum products. The average energy content of a gallon of regular gas is 125000 BTU/gallon.

In Minnesota we are mandated to burn a blend of 10% ethanol/90% gasoline. This blend represents 120,960 BTU/gal. When the rest of the country is paying $4.00 per gallon of regular gasoline we should be paying about $3.87/gallon of gasohol if we go solely upon energy content (or less because ethanol is much cheaper per gallon than gasoline). Mileage estimates should also be about 96.7% as well.

How would it be if the FDA allowed “blended drugs”? Adding 10% of inferior (sub-potent) drugs to each batch would result in 96.7% of the seizure control, cardiac effects, pain control, or bacterial killing. Could we live with that amount of inferiority for a 4.3% reduction of the national drug bill? For most drugs and diseases, this amount of drug reduction would be no big deal. The FDA actually already allows 5% variability in content uniformity for most drugs. Would consumer groups and the AARP scream bloody murder if prices were not also proportionately reduced? More than likely.

How does a 100% reduction in the drug costs sound? Rational use of antibiotics would prevent the use of antibiotics in patients with viral disease; saving the patient and the payer 100% of the cost of the antibiotic. Society would further benefit through reductions in antibiotic resistance. Medication management is the real “Tiger in your tank” if you want to get the most out of the money spent on drugs.

ps. Best answer this week to the question "How are you?" was "Better than the Celtics and Turkey's soccer club combined”

Specialty drives salaries. Family practitioners ONLY make $173K/yr. (How do they afford gasoline?) Specialty practice nurses in anesthesiology make more.

New breed of pharmacies refuse to stock condoms, oral contraceptives, or the abortifacient, “morning after” pill. This goes beyond the right of individual pharmacists to refuse to fill certain prescriptions or sell otc products. With the huge “Pro-fife” movement, this approach may be the way for the “Mom and Pop” drug stores to compete with the K-mart and Target pharmacy chains.

I contend that all patient’s are 100% “compliant” with their own “perceived self interest” when it comes to drugs. They may be “non-compliant” with the physician’s orders. Rather than complain about certain side effects, they opt to reduce dosage or stop taking prescribed meds. It is the job of physicians, pharmacists, and health educators to explain the “WHY” of drug therapy so that patients UNDERSTAND the choice they make when they do not take their prescribed doses. This study shows a three fold increase in mortality in patients with epilepsy who take less than 80% of the prescribed anticonvulsants. ER visits also rise. http://news.yahoo.com/s/nm/20080618/hl_nm/skipping_anti_epilepsy_drugs_dc;_ylt=AqukYq1vyvWueAgQFpGGJZOCSbYF

FDA goes after sellers of fake/unproven “cancer cures”. FDA names names. Consumers should be aware of this list and should NOT buy anything from them. General press release is at http://www.fda.gov/bbs/topics/NEWS/2008/NEW01852.html

Xopenex is a single enaniomer of albuterol (Proventil) and is used in respiratory care of asthma and shortness of breath. Proportedly, Xopenex causes fewer side effects but isn’t considered worth the added cost over generic albuterol by some. Rational use should revolve around initial albuterol use with Xopenex held in reserve for those who experience adverse events from albuterol.

Centocor/Orth Biotech Services recently sent a letter to health care professionals after a transport trailer containing cartons ofr Procrit, Doxil and Remicade was stolen and not recovered. The drugs are expensive and require refrigeration. Whoever stole the drugs may not be as conscientious about storage conditions as a real pharmacy. The drug lots are being recalled as both a safety issue and to remove the market potential for the highjackers.

Decrease in mortality risk for long term coffee drinkers. Up to 6 cups of caffeinated or decaf appears to increase longevity, especially for women. (I’m glad because I wouldn’t stop if the reverse were true)

Disclaimer: "Pepin's Pharmaceutical Prattle" (AKA "The Prattle") is the property of PHARMWORKS, LLC and Steven M. Pepin, Pharm. D. 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 spepin@pharmworks.com . All insightful comments from readers are thoughtfully considered (the rest are callously discarded). Copyright 1998-2008 PHARMWORKS, LLC all rights reserved.

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