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3 posts from December 2012


Brand Name and Generic Drug Manufacturers Teaming Up? Proper Drug Disposal as the Common Thread

Brand name and generic manufacturers are finding a reason to team up...against a local California municipality.  Alameda County passed a law requiring drug manufacturers to establish, and fund, a mechanism for consumers to properly dispose of their medications.  Proper disposal of medications will help minimize the environmental exposure to potentially harmful chemicals such as hormones, antibiotics and other drugs.  Most experts agree that a majority of the medications get into the environment through human and animal urine/feces containing the drugs or their metabolites.

Currently, sewage treatment plants are not designed to remove these substances so another strategy is to limit the exposure by preventing the drugs from getting into the environmnet.  Drug take-back programs, such as the one called for by Alameda county, are costly.  A similar program in British Columbia costs about 1/2 million dolllars a year to run, for about a population of 4 million people.  If this catches on, this would be a costly venture for drug manufacturers, to say the least

PhRMA, the Generic Pharmaceutical Association and the Biotechnology Industry Organization are jointly filing a lawsuit in the United States District Court in Oakland on Friday.   Only time will tell how this shakes out.  For more information, see the New York Times article . 


State-based Insurance Exchange bill vetoed in NJ

The fact that Chris Christie vetoed a bill which would have allowed insurance exchanges to operate in NJ indicates that he does not have confidence in the implementation of the insurance exchange program developed under the affordable care act.  New Jersey will default to the Federal Option.  NY and CT  declared moving toward a state-based exchange system while DE is utilizing the State Partnership Option    Selection of a state-based, federally based or state-partnerships must be declared to Secretary Sebelius by December 14, 2012.  State-based exchanges maintain control over which qualified health plans (QHPs) operate within the state while partnerships utilize a combined state/federal management model with the hope of transition to a fully-funded state-based exchange.  Those declining to establish a state-based exchange default to the federally managed option wherein the federal government will adopt a clearinghouse model and allow any QHP and will determine individual eligibility for tax credit and cost-sharing benefits.  Citing the unknown cost to the NJ residents, Christie opted for the federal option, also without knowing what the cost will be for the residents.   Only time will tell how this new healthcare world will unfold.


Pharmacy-Assisted Suicide - at CVS, Rite Aid, Walgreens, Walmart, etc.

By Dr. Daniel A. Hussar is the Remington Professor of Pharmacy at University of the Sciences' Philadelphia College of Pharmacy. He serves as the author and editor of The Pharmacist Activist newsletter (http://www.pharmacistactivist.com) from which this editorial was taken.

Suicide by smoking cigarettes! "Warning: Smoking Can Kill You," is the title of an editorial in The New York Times (August 27, 2012). It is a slower death than what we usually associate with the word "suicide." But premature death is the consequence for many smokers. More than 400,000 Americans die each year as a result of disease and complications from smoking. Smoking cuts lives short an average of 13 years. Suicide is intentional, not accidental. As one smoker has noted, "I never smoked a cigarette by accident."

Physician-assisted suicide prompts emotional debate, and even outrage. Pharmacy-assisted suicide - selling cigarettes - is ignored by most and is an outrage to only a few. The use of the word "Pharmacy" rather than "Pharmacist" is intentional. The vast majority of cigarettes sold in pharmacies or retailers that include pharmacies are sold in chain pharmacies, grocery stores, and retailers like Walmart. It is not the pharmacists who work in these locations who personally sell cigarettes or who have the authority for the decision to sell them. Indeed, it is my opinion that an overwhelming majority of the pharmacists employed in these stores would not permit the sale of these products if they were able to take that action without fear of retaliation from management. Rather, it is corporate management, most of whom are not pharmacists, and specifically the CEOs, who are responsible for the decision to sell cigarettes (please see my editorial, "Merchants of Death - Chain Pharmacy CEOs Must Stop the Sale of Cigarettes!" in the November 2011 issue of The Pharmacist Activist).

Some chain updates

Various recent events and situations call further attention to the hypocrisy of the largest chain pharmacies that try to create an image of being interested in the health of their customers while continuing to sell the product that is the most preventable cause of death.

CVS - Dr. Terence Gerace is the National Coordinator of the CVS Sells Poison Project. The "Poison" is cigarettes. He has conducted 122 peaceful protests outside of CVS pharmacies in the Washington, D.C. area to publicize the harm that is caused by their sale of cigarettes (www.Toxic-TobaccoLaw.org/13news.shtml#CVS). Protests 121 and 122 were held outside of the Four Seasons Hotel because the CEO of CVS was to participate in The Wall Street Journal's annual meeting of the CEO Council. Information regarding the discussions that occurred at this forum is included in the November 19 issue of The Wall Street Journal. The CVS CEO is identified as a co-chair of the group addressing the topic, "Remaking Health Care." The summary of the discussion of this topic refers to ideas such as "...looking at the agricultural subsidies that might contribute to bad habits like smoking..." However, there is no reason to think that anyone mentioned or dared question the CVS CEO about the role of his company in the distribution of the product that causes more harm and death than any other product. Dr. Gerace is to be commended for his commitment to increase public awareness of this hypocrisy. CVS ignores him but hundreds of passersby applaud his concern.

Rite-Aid - Earlier this fall it was announced that Rite Aid was unveiling the next generation of wellness store. A ribbon-cutting ceremony that included company and community officials was conducted at the grand re-opening of the store located near Rite Aid headquarters in Pennsylvania. Among the areas featured are an expanded men's grooming area, a nail bar, a hair care aisle, and a grab and go cooler ("for quick pick up of milk, eggs, and other convenience items"). Identified at the end of the announcement are "expanded clinical pharmacy services with pharmacists specially trained in diabetes care, immunizations and medication therapy management," [editor's note: assuming the pharmacists have the time available after dispensing the number of prescriptions management expects before more personnel are provided.] Reference is also made to the newly designed smoking cessation department (it is an exaggeration to call this display a "department"), but it is much smaller and less prominent than the area where cigarettes (featuring Marlboro) are sold at the check-out at the front of the store. The Rite Aid chief operating officer is quoted as saying, "We know our customers' health and wellness needs are always changing." That is fine but there is one health fact that doesn't and won't change - Smoking kills! However, Rite Aid ignores its role in encouraging smoking and continues its charade of pretending to be interested in the wellness of its customers.

Rite Aid management gives every appearance of taking positions based exclusively on the financial implications for the company. In a recent situation, Rite Aid took a position that essentially denied that pharmacists are health care providers. Fortunately, a Superior Court judge, based on her determination that pharmacists are health care providers, ruled in favor of the plaintiff and against Rite Aid (Landay v. Rite Aid). I have tried to meet with Rite Aid executives to discuss this situation, as well as its sale of tobacco products. They do not respond, which is perhaps an understandable strategy if there is not a valid response.

Walgreens - In addition to conducting protests outside of CVS stores, Dr. Terence Gerace has communicated his concerns to Walgreens regarding the sale of cigarettes in its pharmacies. He received a response from a customer relations specialist identified as Wendy B. Apparently the level of guilt associated with efforts to defend their management's decision to sell cigarettes has resulted in the respondents not wishing to identify their last name. Aside from not disclosing her last name, Wendy B. is candid. She notes that "Many of us at Walgreens have personally lost good friends to smoking and cancer." She further notes, "While we've made a business decision (but not a personal one) to continue selling cigarettes, it's a decision we constantly review." Her letter continues: "If Walgreens stopped selling tobacco products, we'd lose sales from the other convenience items that smokers normally would purchase while at our stores. That's not good for our employees, our shareholders or the convenience of the more than 20 percent of Americans who still smoke." With a response like this, I can better understand why Wendy B. does not identify her last name. Walgreens' concern for the convenience of its customers who wish to buy cigarettes can't justify its lack of concern for their health.

Earlier communications

My first communication with the CEOs of CVS, Rite Aid, Walgreens, and Walmart encouraged them to be a leader among chain pharmacies in discontinuing the sale of tobacco products, and also requested the opportunity to meet with them. None of those individuals, or their successors in the position of CEO, has been willing to meet with me, although I was able to speak with an executive (without decision-making authority) at three of these organizations (Walmart being the exception). In these discussions I encouraged the consideration of strategies through which the loss of revenue resulting from the discontinuation of cigarette sales would be replaced or exceeded by the sale of products or services that have health benefits. I encouraged them to involve their pharmacists in submitting recommendations and provide a bonus for the best ideas. I observed that a decision by the first, and probably the second, of these companies to discontinue the sale of cigarettes would result in more positive national publicity than even their large company could afford to buy. These efforts have failed but the experience has made me all the more determined.

It is noteworthy that, during this same period of time, a very important pharmacy initiative - immunization - has been implemented that has been not only of great value in protecting public health but also has been a source of substantial revenue for pharmacies. Some chain pharmacies have viewed the provision of immunizations at any time a customer requests one to be so important that they have required every one of their pharmacists to become certified to provide immunizations. The revenue to be generated from immunizations must be substantial because some chains have fired pharmacists who do not obtain this certification.

I have learned that there is only one thing that gets the attention of the CEOs of these chain pharmacies - MONEY! And when professional initiatives like immunization generate revenue, the obsession becomes MORE MONEY, rather than a willingness to discontinue the sale of the product that causes addiction, disease, and death. I do not like calling these individuals merchants of death or referring to their decisions as pharmacy-assisted suicide. I would be very pleased to applaud and congratulate them if they stopped the sale of cigarettes. However, I consider the current situation to be a huge contradiction and embarrassment for the profession in which I am proud to be a member. I have become convinced that nothing short of the strongest of terms and outrage from the profession of pharmacy and the public has any chance of convincing the CEOs of these chains to stop selling cigarettes.

New strategies are needed

Bolder and widely-publicized strategies are needed to get cigarettes out of pharmacies.

The following ideas come to mind:

A public opinion survey with the question - Which of the following retailers sells the most cigarettes in the United States (and, therefore, is responsible for the most smoking-related deaths)?
  1. CVS
  2. Rite Aid
  3. Walgreens
  4. Walmart
Highway billboards identifying the estimated number of smoking-related deaths in 2011 in a particular state based on the number of cartons of cigarettes sold by a particular chain pharmacy in that state during that year.

I have additional ideas but have run out of space in this issue. I know that readers will also have strategies to suggest.
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