Commentary: Hey, Big Pharma, show us the ads

October 15, 2010

For this pharmacist, the best education is in magazine advertisements. The ads give the big three: What the drug does. Why it is better than the others on the market. What the dangers are.

Recently, EricRPh left this on Twitter: "That's right, Doc, just saved your butt on that script where you would have overdosed that kid. You're welcome."

Pharmacists have been saving prescriber hind ends for decades. Doctors expected us to do this quietly. We took the phone over to the corner where no one could hear us. We covered the doctor's butt and when he neglected to say thank you, we were supposed to forget it ever happened.

My Bachelor of Science degree is from 1964. I don't know what the 2000 PharmD knows, but I am quick to react when I see a danger sign, and the more I counsel, the more patients I see in jeopardy.

I counsel on every new prescription, and I have been noticing that I see more bad drug therapy than ever before. Talking to the patients reveals issues that did not cross my mind at the Prescription Mill.

Case in point

Recently I took a vial of SMZ/TMP (sulfamethoxazole-trimethoprim) double strength to a young man at the register. I asked him what he was using it for. I expected him to say "sinus infection."

He smiled grimly and pulled the neck of his T-shirt over his shoulder and there it was. It looked like a small angry red golf ball with numerous pustules.

"How long has that been there?"

"A couple days," he said.

I looked at the prescription vial and must have frowned.

"What's wrong?" he asked.

"This drug," I said. "That hickey you have is either the damn-dest carbuncle I have seen in years or I am a goat."

"I saw the doctor a week ago." He touched the lesion. "This was just a scratch."

I offered to call the doctor and had him on the line a couple hours later. I told him about the blossoming carbuncle and said, "I don't think that SMZ/TMP is a good choice for staph."

He hemmed and hawed and finally said, "How about Vancocin?"

"Too toxic for the first go-round."

"Well, what would you choose?"

"Levaquin."

The doctor said with authority, "I'll prescribe Levaquin for this boy." Good idea, Doc.

That scenario will be repeated thousands of times every single day. Counseling provides opportunities that do not exist at the Prescription Mill. Before long, pharmacists will be prescribing on a wholesale level. The doctor is going to be too busy. You know more than the doctor, for goodness sake. It's a no-brainer.