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Pepin's Pharmaceutical Prattle for 08-17-2009

 Quote of the day: Nobody believes the official spokesman...

                  but everybody trusts an unidentified source.

                            Ron Nesen

Good Morning!

A treat this week, you don’t have to listen to MY ranting. A loyal reader was set off by my “HBO?” editorial a few weeks ago. The following was the unedited response.

 I must be getting  more opinionated as I get older.  What follows is meant to inform not offend.  

Given the democrats control both houses and the presidency - If  Obama  care is passed how would it be implemented?  An analogy will help explain the question.  For example a school board can set policy that sets out goals and objectives such as the school needs a foreign language  for better more well rounded students.  In the case of the government this is the legislation process and bills are passed. The real operational details gets added when the implementation starts. For a school that is the principal and administration who do the daily operations schedule the classes, choose the teacher etc.  For the government it is the advisors and government committees who write the rules and operations which become operational policy. President Obama has said on multiple occasions that you can see how he aligns & his thinking by the his advisors and the people he chooses to be around him. Below are 3..

Obama has a set of advisors advising him on heath care including his Science Czar John Holdren.  Who in the book Human Ecology: Problems and Solutions, which he co authored,  has advocated forced abortion, sterilization via chemicals in the drinking water  and that children are not fully human until they are socialize and fed. Don’t believe it.   Google  Obama Science czar forced abortion  or Obama Science czar sterilization or “Obama Science czar new born child”. 

Remember president Obama Czar’s are not subject to congressional oversight and approval like cabinet members –  president  Obama has 32 Czar’s.

Another special advisor specifically for healthcare is the brother of Obama’s Chief of Staff, Rahm Emanuel,  Doctor Ezekiel J. Emanuel.    Dr. Ezekiel Emanuel is the Chair of the Department of Bioethics at The Clinical Center of the National Institutes of Health and  is an advisor to President Obama on Healthcare.  Dr. Ezekiel Emanuel wrote an article for The Hastings Center Report in 1996, in which he suggested that public deliberative forums should decide which health services should be socially guaranteed, and that those services "that ensure healthy future generations, ensure development of practical reasoning skills, and ensure full and active participation by citizens in public deliberations" might be considered by this deliberative body as "basic", while "services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed". He goes on to give examples illustrating these concepts: "not guaranteeing health services to patients with dementia", while "guaranteeing neuropsychological services to ensure children with learning disabilities can read and learn to reason".

Now you may say that was 10 plus years ago – things change – so look what he said this year -  Jan 31st 2009, he published  another article on a similar topic which he coauthored,  titled "Principles for allocation of scarce medical interventions" in The Lancet Journal in the UK. The article describes  his method of "Complete Lives System": It "produces a priority curve on which individuals aged between roughly 15 and 40 years get the most substantial chance of healthcare , whereas the youngest and oldest people get chances that are attenuated." He goes on to explain why the "death of a 20-year-old woman is intuitively worse than that of a 2-month-old girl," Each person's life is not equally important,  and in his view, not sacred. Seems like his opinions have not changed

Below is the "priority" graph  Dr. Emanuel advocates, notice how much priority infants and those over 55 get for health care. How old are you?

Peter Singer is another Obama advisor  who supports QALY ( Quality Adjusted Life Years) to quote him in a July 2009 New York Times article “As a first take, we might say that the good achieved by health care is the number of lives saved. But that is too crude. The death of a teenager is a greater tragedy than the death of an 85-year-old, and this should be reflected in our priorities. We can accommodate that difference by calculating the number of life-years saved, rather than simply the number of lives saved. If a teenager can be expected to live another 70 years, saving her life counts as a gain of 70 life-years, whereas if a person of 85 can be expected to live another 5 years, then saving the 85-year-old will count as a gain of only 5 life-years. That suggests that saving one teenager is equivalent to saving 14 85-year-olds.”  You can read more at  or the NYTimes article itself

 Hard to believe the white house is asking  you to tell on your neighbors - the  link to the white house blog, asking for citizens to tell on other citizens is  You will find the request just below the video Facts are stubborn things. Yes Facts are stubborn things.  The 1st video in the blog talks about fishy disinformation and the real facts on health care.  Speaking of Facts  fishy health care and full disclosure; the video is highly selective in what it shows.  Yes, Obama states today that you can keep your current health plan and physician, if you like them and he is not for a single payer(Government ) system. However if you look at the history of what he has said, some of it recent,  that is not accurate.. He has promoted  a step wise (Trojan horse ) approach to a single payer ( government) system.–   In his own words – watch and listen to Obama  ( 3 times ) beginning, ½ through and at the end  -watch it and you decide what is his position on Health care

 Whatever you position is, make sure your congress representatives and senators know what your opinion is. 

 Thanks for putting up with me and my soap box. 

 I couldn’t have said it better myself! The author is afraid of retaliation etc so asked not to be identified. If you have a response and want to be identified (or protected) send it to me… it would make a few of my Sunday evenings a little less hectic.

Have a GREAT week!



ps. Best answer this week to the question "How are you?" was "I'm finer than frog hair!"

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) I am sad to say/ecstatic to say FDA approves another drug for/against bipolar disorder

Saphris (asenapine) was approved to treat bipolar disease and schizophrenia. Worked better than placebo against each disease. Has many of the same side effects as the other antipsychotics. Will be interesting to watch this one.


2) I get no kick from Champagne …

New dosage form for extended release morphine will release but is “tamper proof”. The Embeda formulation contains a drug that will block the effect of morphine if the capsule is crushed, chewed or dissolved in alcohol in order to make it ‘FAST RELEASE” and more abusable.  I believe that the brand name came from the fact that the antidote is embedded in the pill.


3) Not-so-secret $80 billion deal

Details of the Pharma/Obama deal released (both sides had denied its existence). Memo lists 4 tangible Pharma giveaways and 4 administration mushy promises. I think that the “deal” was a lousy one for Pharma.



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4) Not a witch hunt.

Salem News reports that Medicare Part D premium will only rise a little bit for 2010. Will go up about $2 per month to $30 per month. (That is just over 7.1%) Small but not insignificant rise.


5) FDA warns about test strips for blood glucose.

Test strip results may be false if patients are taking non-glucose sugars, including maltose, xylose, and galactose, tahat are found in certain drug and biologic formulations. See the article for specific interacting drugs and a list of the test strips affected. (Yes… Accu-Chek is on the list). Problem arrises when these non-glucose sugars are picked up by the machines as glucose. The resulting falsely high reading would prompt the administration of too much insulin. A must read for hospital based pharmacists.


6) Monkey business and a cure for baldness.

Allergan is set to test its eyelash enhancer (and glaucoma drug). Bimataprost, on the stumptailed macaque. The monkey goes bald naturally so it may make the perfect study species. Too early to tell if this will go anywhere. If trails start soo it may take 8 years before a product could come to market.


7) Keep up the heat… “They” got out of the kitchen.

“Public option” is likely going to be taken off of the kitchen table due to the intense heat generated by the public outcries against it. I still don’t trust that it will stay off of the table unless we all continue to direct our senators & congressional representatives to represent the interests of citizens above the administration. Talk continues on a non-profit alternative (I suspect that this option would be governmental directed not just government regulated).






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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