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Pepin's Pharmaceutical Prattle for 08-03-2009

 Quote of the day: I don't want to achieve immortality

                 through my work...

                 I want to achieve it through not dying.

                          Woody Allen (1935 - )

Good Morning!


In grade school I didn’t understand all of the talk about the Youth in Asia. I thought it had something to do with the milk money I had sent to feed the kids in Asia who had no milk to drink. I had other important thing to think about; baseball, baseball cards, homework, and baseball (in that order). In high school I learned that the subject was euthanasia but passed it off as too far fetched and ludicrous for anything to come of it in the real world… besides, there was now football to think about. In college the subject kept coming up, especially at the secular institution that I attended so I spent some effort on the subject.

It turns out that euthanasia can be divided into two basic types: passive and active. (Passive: you let someone die. Active: you kill them). Another binary division is between voluntary and involuntary (Voluntary: you go on your own. Involuntary: someone else decides and you go kicking and screaming!) This can be represented by a grid.

Voluntary/Passive: You decide when you will let Nature take its course. Patients in hospice care are made as comfortable as possible after exhausting reasonable measures to prolong their lives. Each patient determines how much is “enough” and elects to accept the final outcome.  “H” is for hospice.

Voluntary/Active: You decide when you will die and find someone to help you end your life. In Oregon (and other places) the “right to die” folks have pushed through legislation that makes it legal to actively kill patients who want to die. “O” is for Oregon.

Involuntary/Passive: Other people decide that your use of resources is not justifiable so care is denied and you die. Expect to see a lot more on QALYs (Quality Adjusted Life Years) as a way to determine how much money your final years are worth.  Could “B” be for ‘Bamacare?

Involuntary/Active: The stuff of Sci-Fi movies of years gone by. Anyone remember Soylent Green (1973)? Could we be headed for that box as our final destination?

 The cost of treatment and the expected outcome in terms of Quality of life are calculated as a way of rationing care. In the House bill on health care reform there is a section titled “Consultation and Information Regarding End-of Life Planning” (section 1235). Some have seen this as a chance to promote earlier “retirement” from this plane of existence. Obama claims that this optional (voluntary) service offers seniors the opportunity to make a “living will”.

In Minnesota we had a “passive” seat belt law. While seat belts were mandatory you could not be stopped by the police primary for not using your seat belt. If stopped for anything else the seat belt violation could be added to the citation. The use of seat belts did not rise to the level determined to be acceptable by the State. The simple solution was to change the law so that police officers could stop and ticket those who were doing nothing else wrong except driving without their seatbelts fastened. As healthcare costs accelerate under ‘BamaCare I wonder if the same logic will apply and some of us who are not as productive as others and who use “too many resources” will be shifted into the Involuntary/Active block. As this debate rages on in the headlong race for “Universal” coverage, fasten your seatbelts!

Have a GREAT week!



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

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) Tylenol 500mg as prescription only?

The use of acetaminophen is being reviewed again. Previously an upper daily limit of 4000mg was established in an effort to avoid liver damage. The new limit proposed would be 3000mg. There is also talk of leaving the 325mg tabs as OTC but moving the 500mg tabs to prescription only. (like patients could not do the math!). It is more likely that patients would take 3 of the 325mg tabs instead of 2 of the 500mg tabs. It is a shame that people making suicide gestures with a substance that they think is “safe” are actually killing themselves. I doubt that a change in strength is going to do anything about that but the lower daily limits might just save some livers.


2) Onglyza (Saxagliptin)

New once daily oral drug approved by the FDA to treat type 2 diabetes. The drug essentially whips the pancreas into releasing more insulin. New release blithely states that the drug is to be used “with diet and exercise”. Good luck with THAT one.


3) Senator speaks before recess…

Senate committee member says that any Senate health care bill is not ready for prime time. Polls show that the popularity of healthcare reform is waning. Let’s hope that constituents talk to the bullies on the playground during recess and convince them to mend their ways.


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4) What can’t manage its own allowance?

The GAO (government accounting office) states that the FDA can’t manage its own finances because it lacks the data on which to make internal assessments. Does not have the expertise to project a budget let alone stay within it. I’m sure that the GAO would like nothing better that to take over the task.


5) Congress just does not understand PBM’s and networks.

CVS is under congressional scrutiny for charging a higher copay for out of network claims. I suspect that networks will become a thing of the past under ‘BamaCare as every ounce of competition of wrung out of the system. Woe to the PBMs.


6) ‘BamaCare wants to “negotiate”

The House of non-representatives has passed out of committee (“thank you” Chairman Waxman) the Democrat/Obama’s Health care reform which sets it up for debate in September. I wonder how many in Congress will ACTUALLY read the 1,017 page document… In addition to all the other havoc that this bill will create it would allow the government to negotiate drug prices for Medicare recipients. We have seen “them” negotiate before (twisted arms in their wake). Go Blue Dogs!


7) Battle of the Bulge heats up

Boomers and X-ers want the fat and calories but not the pounds and inches. Thus the arms race for the next “Safe” fen-phen. Vivus has come up with a concoction that might fill the bill; phentermine and topiramate. Read about other small pharmas that will become big pharmas if they receive approval for THEIR entry into the race. Until then you still have the only things that really work: diet and exercise.






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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