Life as an Extreme Sport

The Daily – Pharmacists’ moral acumen

Pharmacists’ moral acumen
2006-04-24

One of the more interesting and underrepresented facts about many women’s health providers — places that are routinely targeted because they provide low- or no-cost birth control for women, as well as access to abortions — is that they often offer other health services, such as flu shots and general health exams.

Sometimes, antibiotics are prescribed.

Most of these clinics don’t have on-site pharmacies, so it is up to the patient to go elsewhere to have the prescription filled.

Or, as was the case with a patient from the Cedar Rivers Clinic, which has facilities in Renton, Tacoma and Yakima, Wash., the prescription is called into a pharmacy for pickup.

Unfortunately, in May 2005, a pharmacist at the Swedish Medical Center outpatient pharmacy took it upon him or herself to decide it was morally unacceptable to receive antibiotics from a clinic that provides access to birth control and abortion, and refused to fill the prescription.

That’s right. A pharmacy refused to fill a prescription based on who prescribed it.

“Well maybe,” you try to rationalize to yourself, “the pharmacist believed that it was an abortion-related complication and they felt complicit?” Ignoring the logic behind that, which basically says that someone deserves an infection, let’s move to another example.

At a Safeway in Yakima, Wash., a pharmacist refused to fill pregnancy-related vitamins for a pregnant woman who was receiving healthcare from Cedar River Clinic. This is a woman who was making an active effort to have a healthy pregnancy.

The Safeway pharmacist reportedly repeatedly quizzed the woman why she needed the pills (seems obvious to you and me, eh?), and then launched into why she was going there.

There.

As if the woman should be castigated for receiving healthcare for her pregnancy.

My friends know that I often play devil’s advocate for pharmacists who decline filling Plan B or chemical abortificant prescriptions on moral grounds.

My reasoning for this is that in some ways you can argue that the filling of these prescriptions does directly force the pharmacist to participate in the providing of a service they morally oppose — what they view, rightly or otherwise, to be abortions.

We do not force doctors to perform abortions on women who want them, and I think it’s reasonable to extend this logic to pharmacists.

But these pharmacy moral-police are overstepping their boundaries when they begin denying prescriptions based on who writes them.

If a pharmacist decides he or she has the moral acumen to decide if someone should or should not have access to antibiotics, what’s next?

Denying someone their AIDS cocktail?

Refusing to fill someone’s prescription for methadone, since maybe they’re lying about having chronic pain and they’re really a heroin user in recovery?

Maybe these morally righteous pharmacists will determine that you shouldn’t have access to any “Class II drugs,” or that you’ll need to provide documentation of your illness before they release the prescription to you.

The potential nightmares can be spun out for a while.

Thankfully, the Washington State Pharmacy Board realizes the potential for abuse, while also recognizing the right of the pharmacist to conscientiously object to some prescriptions, such as Plan B.

Late last week, the board released its first draft of a new rule outlining a pharmacist’s right to refuse prescriptions.

While the exact wording of the rule remains uncertain as it undergoes further revision, so far the indications have been pretty clear: Pharmacists have the right to a conscientious clause only so long as there is another pharmacist on site or closely nearby who can fill the contested prescription.

Which is how it should be. Pharmacists dispense medicine, they don’t practice it.

What I’m Reading Today

The miscellanious round-up, while I wait for the coffee to infuse my system enough to pack and wander my way towards the airport.

Pfizer Boldly Advertising Celebrex Again – but with a big ol’ warning about the risk of heart attack and/or stroke.

I took Celebrex for a year, maybe more, and have to admit it made my life a lot easier during that time. At the very bottom of the article, Michael Krensavage, a drug industry analyst at Raymond James, says “I would try an ibuprofen first.” Well, thanks Michael K – but I did, and I was taking like 10 ibuprofen a day, which is never good for the liver, and still getting no pain relief. One Celebrex later, and I could move without wanting to cry (this was back when my rotar cuff was torn).

All drugs carry risks and benefits. It’s up to you and your doctor (note: doctor, not pharmacist) to determine what the right drugs are for you.

And lest anyone think last weeks Bones episode The Graft in the Girl, was just more scary science fiction, Stolen body parts linked to patients’ illnesses; several lawsuits claim tissue transplants were infected with viruses and other germs. Four men, one of whom worked for a tissue provider, have been charged with carving up corpses and selling their parts without consent. And oh yeah, they’re diseased and old and damaged parts.

Quite literally the entire plot of the last Bones, down to almost the exact same name of the tissue company. Life, meet art. Art, meet life.

GlaxoSmithKline, Europe’s biggest drugs manufacturer, yesterday defended itself against accusations that it is turning healthy people into patients by “disease mongering” and pushing “lifestyle” treatments for little-known ailments. Charming, ‘cept I don’t believe a word of it. I’m actually having fun collecting a list of all the drug advert commercials I see – I figure it will make a nice column for The Daily.

I particularly love the line “It is easy to trivialise things when you don’t have them. If people did not want the treatments, they would not seek them.” …or, you know, people wouldn’t think about it being an issue if they weren’t told it was one. We spent a while talking about the concept of taught illness in my philosophy of medicine class last quarter. Perhaps I should interview Sara for the article, heh.

Wired has another take on the pill pushers, noting that although Novartis employs some of the most brilliant minds in the pharmaceutical research field, developing impressive leukemia fighting drugs like Gleevec, their fourth most profitable drug is Lamisil.

Lamisil treats toenail fungus. It’s not life threatening. It turns your toenails yellow. And for three months and about $850, you can cure it. And 10 million Americans have, or are trying. And yet, in those numbers, a very small percent have had what you might call a significant reaction to Lamisil – they’ve died.

And yet because of their effective marketing campaign, with Digger the Dermatophyte, a campaign costing them $236 million in three years, Americans are lining up to take a drug that only completely cures 38% of them.

That’s a pretty low cure rate for a mostly invisible (after all, most of us wear closed-toed shoes) fungal problem that does nothing other than making your toe nails yellow.

Can I market a new cure for toenail fungus? I’ll call it… Polimisil. It’s a simple treatment, involving the application of a tinted liquid substance that dries to the toenail, masking the originating colour of the nail. You get approximately 60 treatments per bottle, each treatment lasting about a week. And for this amazing cure, I’ll only charge you $40 a bottle! That’s less than $1 a treatment!

C’mon, you know you want to!

On the other side of the pharmaceutical fence, (wow, I’m just all big pharma lately), Genzyme won FDA permission to sell a new drug to treat Pompe disease, a rare inherited enzyme disfunction. One of the problems with big pharma is that since they are businesses, they have incentive to develop and produce drugs for common problems, like arthritis, so they can make lots and lots of money. Practically speaking, this means that rare diseases, like Pompe, are often overlooked, because there is simply not the client base that would justify the research and development costs.

In doing something right for a change, our government has developed an incentives program for companies developing treatment for these rare illnesses; in fact, that’s what Genzyme specializes in.

Faith Healing and the Body

Tonight’s episode of House dealt with the idea of faith healing, something that comes up a lot these days in medical journals. What is the power of prayer? Does faith healing work? Can miracles happen?

I realize it’s a symptom of my interdisciplinary training, and perhaps of being under Phillip’s thumb in particular, but I think a more interesting question is why miracles can’t happen? After all, a miracle is just that which we don’t understand. As has been often remarked, our technically is magic to those who don’t understand how it works, as is often our medicine. The typical example is a cell phone in the rain forest, although I’d argue there’s an awful lot of technology and medicine that might as well be magic for our understanding – there is simply the belief, the faith that it will work, because someone is being told it will work.

How is that so different than hearing a faith healer tell you the same?

Of course, we of the rational, medical type say we have medicine, we can take the time to understand how technology works. But we can’t fully understand how the body works; we keep finding new things, miracles keep being rationalized and understood, filed away into things to learn and knowledge to distill.

If we have learned one thing, it’s that the body is an amazing thing. Who’s to say that the power of the placebo effect, the mind, isn’t enough to help some people? We know, scientifically, medically, that positive thinking does positively affect our health, including to help us recover from illness. Who knows?

We don’t, so it gets filed away as faith healing fakery and fraud. But in ten years, perhaps it will have a Latin name and a textbook. That’s the way knowledge goes, a part of life for both miracle and medicine.

Strangeness Abounds

My parents just left, taking away the first carload of my stuff. Almost all my books are gone, as is one of my shelves, my teacups, a hanging lamp, other stuff. Anything small and free that could be lifted and removed.

The place doesn’t feel bare, or stripped – I put my foot down about a few items – but it does feel larger, emptier…

6 weeks.

I’ll be gone in 6 weeks.

Shay Saves the Day

I took Shay’s advice, after pounding my head against my thesis so long I swear I’ve a large purple bruise on my forhead. I collected together all my writing in one document, in roughly the order I thought it should all go in. I then expanded around each section, explaining what else I thought needed to go in around these fuller paragraphs.

Suddenly, I have 20 pages of thesis. Which is between 1/3-1/5th of the way done with the project, and 20 pages more than I had yesterday.

More importantly, by far more importantly, I actually feel, now, like this is something I can do.