Letters to the editor: August 7, 2006

I read with interest your Punch & Judy article entitled "Docs vs. R.Ph.s: A Clash of Wills" (Drug Topics, July 10). At the AMA meeting referenced in your article, I presented testimony and physical evidence that, increasingly and without their knowledge, patients are being exposed to health risks associated with nebulizer medications that are unlawfully manufactured under the guise of extemporaneous compounding.

Our evidence is compelling: Some nebulizer vials contain bacteria and/or known airway irritants such as ethanol alcohol and benzalkonium chloride. There are also subpotent vials, vials that contain no medication, and vials that are mislabeled. In all instances, a home healthcare agency and pharmacy were involved in replacing the patient's FDA-approved nebulizer medication with an unapproved substitute. Neither patient nor physician knowingly agreed to use or prescribe unapproved nebulizer medications.

The AMA resolution was intended to target unlawfully manufactured nebulizer medications, but when the "whereas" portions were dropped, this goal was lost. However, the good news is that it sparked a charged discussion where several physicians testified about similar experiences with medications other than those used in our nebulizers. The resolution was recommended for referral because the AMA needs to examine the issues in greater depth. We welcome this approach.

Last week, Gerald Burleson, a pharmacist in Hawleyville, Ala., was sentenced for Medicare fraud and misbranding. A Google search will provide more than enough details for pharmacists and home healthcare agencies who may not understand the risks involved when nebulizer medications are mass-manufactured under the guise of compounding.

While AMA continues to examine the issues, AANMA will continue to report illegal cases to state pharmacy boards and federal agencies.

Nancy Sander
President and Founder
Allergy & Asthma Network
Mothers of Asthmatics
njsander@aanma.org http://www.aanma.org/

Editor's reply: Some compounding pharmacists are indeed flouting the law. But any efforts to control compounding should not throw the baby out with the bathwater!

In-store clinics: A good trend

Regarding your July Instant Poll on pharmacy-based clinics, I believe they are the obvious future of healthcare services in America, considering the rising cost of health care. The classic healthcare foundation with physicians as the sole gatekeepers is broken; in-store clinics are one way to repair it. There are many professionally licensed healthcare providers-physician assistants, nurse practitioners, and Pharm.D.s, etc.-who can make an important and ultimately beneficial contribution to the delivery of healthcare services.

I have obtained a Pharm.D., the degree that is to allow pharmacists a larger, more dynamic role in the delivery of healthcare services, as opposed to the traditional role of providing pills. The trend to place clinics in pharmacies should stimulate us pharmacists to diversify professionally and seize the opportunity for an expanded role as legitimate healthcare service providers.

What is the benefit of understanding the use of ACE inhibitors to inhibit/slow adverse cardiac remodeling in CHF patients, when I am told to sell more FLAVORx for liquid antibiotics because the company makes up to 30% in true profit? Who/what am I? A doctor with no authority. Not for long!

Angel Cloudprettyced@yahoo.com

Letters (including e-mail) should be as brief as possible and sent with the writer's name, address, daytime phone number, and date of the issue you are referencing to: Editor, Drug Topics, Five Paragon Drive, Montvale, N.J. 07645-1742. E-mail address: drugtopics@advanstar.com
. Correspondence may be edited for length and clarity.