Tuesday, August 14, 2012

Day 59 - other parts of the team

I was so upset about the extra trip to Manchester yesterday I neglected to tell you about my visit to the pharmacy where I learned many interesting things, not all of them true.

A family member has a moderate allergy to an ingredient commonly used in pills as a binder. Their doctor gave them some samples, but guess what? ingredient X was present in the small print. Try number two involved writing a prescription for a similar medication, but some detail was not done correctly and my family member got their med with ingredient X, despite having asked the pharmacist to ascertain that there was no ingredient X in the pill. This was sounding like a job for off duty doc.

I went to the pharmacy and spoke with the pharmacist. My first surprise was to learn that she did not believe sorting out which formulation of a medication contains which ingredients was a pharmacist's job. I disagree. It is impossible for anyone else to know which brand of generic a particular pharmacy is carrying at a particular moment in time. Without knowing the details of the brand, one cannot determine the ingredient list. If a patient has an allergy, the pharmacist is the one person in the team who is able to tell exactly what is in the pill and put that information together with what the patient is allergic to, in order to make sure it's safe for the patient. The alternative of the doctor calling the patient's pharmacy and asking which manufacturer of a generic the pharmacy is stocking now, looking up the ingredient list and then sending the prescription is preposterous.

The pharmacist then pulled out the package insert of the name brand version of try #2 and brought it to me to look at. It looked OK so I noted that we would ask the provider to write a prescription specifically for that medication. The next piece of information I learned is that the name brand works better than the generic anyway. I would agree that there are cases where generics and name brands are not equivalent (generics are actually only required to be within something like 20 or 30% of the name brands so for carefully titrated meds this can be a huge problem--seizure meds, warfarin, thyroid meds being the prime examples), but I would disagree strongly with the blanket statement that all name brands are better than all generics. I also happen to know this medication quite well as a prescriber and know that there are not issues with the generic. Having a pharmacist dispensing mis-information about medications is not helpful. My insurance has some kind of financial incentives for us to use this particular pharmacy. I think I know how this pharmacy was able to under-bid the competition--by hiring pharmacists who barely passed their boards, evidently.

I actually didn't say anything to her about either issue because I feel somewhat slow and didn't really fully get what she was saying until two or three exchanges further down the conversation. I think I need to either get comfortable saying, "wait a minute, did you just say blah blah blah" or to metabolize off my chemo more effectively. I'm guessing my behavior will be easier to change than my liver so I'll have to get started on that. It's actually not something I'm enjoying to be a little duller, slower, having a harder time figuring things out. I worry that the new chemo addled Mary is going to be the permanent one. They assure me that one's brain recovers from chemo eventually. I am looking forward to seeing it for myself.

In other, less whiney news, we dropped Ellie off at camp today. It looks really nice and the cabins have running water. The lake is beautiful. I will miss her a lot--in fact, I miss her already. This is her first sleep away experience for more than one night without any family. She has been away from me this long before, but she was traveling with Terry then so this is really different.

Diane came over for dinner and hung out for a little while today. So nice to see her.

Can't think of any other items of interest at this point so I will wish you pleasant dreams.


  1. Oh my..I have a lot I could contribute to this so how much do you want to know?

    I am sorry that someone was not representing my profession well. No excuse for lack of empathy toward someone's allergies. The inert ingredients can create havoc with someone. Particularly, the bisulfites and the coloring agents such as FD&C Red40 and FD&C Yellow6. They tend to be the biggest culprits. Anyone worth their salt with an ounce of curiosity and courtesy should be able to pull a package insert and read one of the very last paragraphs to determine if the medication in question has any of the above or any additional allergic component in question. A call to the drug info department of the company marketing that tablet/capsule is also an option. One I have used several times. I am a research junkie so my customers and the local docs benefit from that OCD trait of mine. This really ticks me off that you had this experience. We may not always be able to provide an immediate answer for someone, but the answer should be retrieved once asked by a clinician and/or customer. I have always been intrigued by the generic/brand argument and therefore have done a lot of reading on this. If interested, I will comment on that as well.

    So happy to see some feistiness sprouting from that body of yours. I think that's a very good sign of things to come.

    If your insurance company prompted you to get medication filled at one pharmacy versus another, I would expect it to be Walgreens or CVS. Boy would I love to know which one it is. Care to share that piece of the puzzle? Hope you had a cheerful, restful day.

  2. I would love to know your thoughts on the generic vs name brand issue.

    We were very happy at Walgreen's and they made us switch to Rite Aid.

    Thank you. I hope you are right about feistiness.

  3. I have a similar issue with pharmacies and a corn allergy. Some medications I have to get compounded but not all meds, like time released cough medicines (tussionex?), which are proprietary formulas. So I have to take the 4-6 hour instead of 12. It works. I have had to call companies to ASK and don't always get an answer. No doubt I have a lot of medications with corn in them but since I'm on quite a few I've kind of given up on it. My allergies aren't bothering me too much right now as long as I stay away from food that lists corn as an ingredient. Of course it's all complicated by the fact that I have started eating a gluten-free diet as suggested by Dr. Trin Meyer. I resisted it for ages but it's easy to stick to it given how much better I feel! Anyway, I do have the same trouble with pharmacies not being that helpful. The best help I got was at Target one day when I was trying to buy something corn-free and the pharmacist's husband has the same allergy as me. Then at CVS I was asking about a benedryl generic (the dye free gelcaps) and someone else in line said her husband has a severe corn allergy (anaphylactic reactions!) and did not have a reaction to the CVS gelcaps.