Introducing....A New Product in the Tylenol Line: Tylenol N&V

At last, it's here. New Tylenol Nausea and Vomiting Formula. No need to take Ipecac when you have overdosed on Nitroglycerine! Treat BOTH the Headache and the Overdose with New Tylenol N&V.

It rapidly relieves your headache while making you throw up to remove the toxin. No need for old fashioned Ipecac Syrup. This one product does it all!!

Of course I am being tongue in cheek with this posting. I am sure you are aware, though, that the Tylenol people have announced a massive recall of certain Tylenol products because they contain a chemical that had somehow gotten into the empty bottles.

Here is an ABC News clip on the recall.

"Hey, Anybody Seen My Bottle of Ginkgo?" I Can't Seem to Remember Where I Put It!"

Ginkgo supplements are among the most wide-selling of all dietary products. Anecdotal evidence suggest that these products can improve cognitive function, improve memory, and proved an overall feeling of well being.

"Not so fast, my friend," as a popular sports broadcaster would say.

A paper published recently in JAMA concludes that this product is ineffective for this and other medicinal uses. Here is a link to the paper: http://jama.ama-assn.org/cgi/reprint/302/24/2663

Naturally, there will be critics of this study saying that there were design flaws, the wrong dose was studied, the wrong extract was used, etc.

Here's what viewers of ABC News saw when they turned on their TV sets. Now, if I could only remember where I filed that video........!!

Neal Beal Stars as "Scrooge" in Dickens' Christmas Carol

Some of you indicated in your survey results that you were not terribly fond of Neal Beal. Admittedly, he could be a little passive aggressive at time, trying to heap guilt onto the poor health professionals who were just trying to do their jobs.

Well, you will be pleased to know that Neal has undergone a transformation of sorts. In fact, what has happened to him parallels the character Scrooge in the timeless feel-good story, A Christmas Carol.

Watch the video below to see a condensed verion of his transformation. You might even see some other "recognizable" characters in this video.

Try JibJab Sendables® eCards today!

I've Heard of Giving Your Boyfriend the Finger, but Never Giving Him YOUR Finger!

Now, this guy's totally messed up. In Arizona recently, a man got angry at his grifriend and cut off her finger. There are some real freaks in this world. Read about this freak from an article in the Arizona Republic newspaper:

Police arrested a man suspected of cutting off his girlfriend's finger with a samurai sword while locking her and his mother in his northern Arizona home Saturday.

A woman called police after her boyfriend, Ronald Gene Olivier, 48, of Rimrock, reportedly cut off a portion of her left pinky and threatened to kill her and his 86-year-old mother if they tried to leave the home, authorities said.

Yavapai County Sheriff Office deputies arrived at the home at approximately 12:30 a.m. on the 4700 block of Drifting Sands Road, Rimrock, to find Olivier's mother, who then told officers he had fled before police arrived.

When asked about the incident, Olivier's girlfriend told police he had been drinking all day and became upset at her over her attitude toward him. Police suspect Olivier locked his girlfriend and mother in a room for an undetermined period of time and threatened to harm them with the sword if they attempted to escape.

Yavapai County Sheriff's Office spokesperson Dwight D'Evelyn said Olivier's temper had been culminating, and the angrier he got, the more violent he became. Olivier's girlfriend told police that, at one point, he came in the room and began striking her with the sword. After two failed attempts by the girlfriend to escape, Olivier told her she needed to be punished by demanding she give up her finger in return for his trust, D'Evelyn said.

Police believe that under threat of death, Oliver placed his girlfriend's hand on a table and cut off a portion of her left pinky finger with the double-edged, 2-foot samurai sword. When Olivier refused to let her recovered the severed finger, she ran to a neighbor's home and sought help, police said.

Police immediately went on a search for Olivier in the surrounding areas. A couple hours later, while the search was still ongoing, deputies were informed Olivier had returned to the home, where police arrested him.

Medics at the scene were able to locate the victim's finger and take her to Verde Valley Medical Center, where doctors were unable to reattach her finger.
Olivier faces charges on counts of kidnapping per domestic violence, aggravated assault, preventing use of a telephone per domestic violence, criminal damage, and resisting arrest.
D'Evelyn said Olivier has a history of domestic violence with at least one assault case earlier this year.

He remained in custody on a $150,000 bond and was due in court the following Friday.

This Research is a Rip-Off!!

Your mother probably told you when you were a kid that taking a band-aid off quickly would actually be LESS painful than removing it slowly. While we accepted her at her word, now comes scientific information to verity that "Dr. Mom" does, indeed, know what she's talking about.

It seems that some researcher in Australia who didn't have much else to do, did a clinical study to determine which method is less painful. Here is the report:

"A randomised trial has found that fast band-aid removal is less painful to healthy young adults than slow band-aid removal, according to a report published in the Medical Journal of Australia.Operators applied medium-sized band-aids to 65 Second and Third Year medical students at James Cook University and removed the band-aids using slow and fast techniques. The students were asked to rate their pain using an 11-point scoring system, with 0 representing "no pain" and 10 representing "worst pain imaginable". "The average overall pain score for fast band-aid removal was 0.92 and for slow band-aid removal was 1.58. The average overall pain scores for women were significantly lower than for men (0.91 compared to 1.64). This may be due to higher pain tolerance, although men did tend to have more body hair," study co-author Dr Carl O'Kane said. "A high body hair score was, not surprisingly, associated with higher pain scores, and it seemed that preconceptions about pain also had an appreciable effect. "The pain experience is a complex and incompletely understood process that incorporates many aspects of patients' social and cultural beliefs, as well as previous experiences. Our observation that preconceptions were associated with pain scores should therefore not be surprising." Students with wounds, documented or suspected allergies to adhesive dressings, chronic pain, or anxiety disorders were excluded from the study. "These results would not be applicable to patients with wounds, particularly chronic wounds and ulcers, which may adhere to band-aids, or other simple dressings. Our sample consisted of healthy young adults and our results may not be applicable to other age groups such as children and older people," Dr O'Kane said. Dr O'Kane said students who were tested by one of the two operators reported higher pain levels than those tested by the other operator. "This may indicate that there are skilled band-aid removers and less-skilled or unskilled band-aid removers," he said.

The Medical Journal of Australia is a publication of the Australian Medical Association. SourceAustralian Medical Association

All in Favor Say....Ouch?????

During the past presidential campaign we heard all kinds of similes and metaphors used to describe the competing interests of the political parties. For example, we heard this: "We are taking our fight to New Hampshire." Or, "the parties are battling one another on the issue of Health Care Reform." Finally, we were likely to have heard "the parties are bashing heads in a hard fought campaign."

Apparently, the politicians in Argentina mis-translated these words and acted them out, quite literally. Watch as you see important political issues being "debated" in the Argentine Legislature.

I think they were arguing over who should "chair" the session.

Marijuana in California: Is it Legal or Not?

This is the second of the NPR Reports. This is curious to me: how can weed be legal, yet also the target of police eradication programs. Make up your minds, California. Is it legal or not?

Medical Marijuana in Humboldt County, California: A NPR Report

Here is Part I of a two part series from NPR about medical marijuana. It speaks to the "growing" (pun intended) interest and use of marijuana as a treatment for several diseases or conditions. It especially speaks about the economics of supplying weed as medicine and the clash of cultures that can follow.

Giving Away Candy in Prescription Vials? What Were You THINKING?

A Sam's Club in Salisbury, Maryland had a great idea to bolster its pharmacy business. Why not hand out real prescritption vials stuffed with Tootsie Rolls and Dots? Well, I could give you about fifty reasons why not to do it, but some jarhead in the front office apparently has never heard that there is an epidemic of drug abuse among young people, nor has he ever dealt with a distraught parent whose kid OD'd on his grandmothers medicine, thinking it was candy.

Check out the full story in the parentdish website:

http://www.parentdish.com/2009/06/30/sams-club-gives-kids-candy-in-pill-bottles/

Two Executed in China Over Tainted Milk

Yes, that's what the headlines of this CNN news story shouted. It seems that in China there is little tolerance for people who jeopardize the health of its people.

http://www.cnn.com/2009/WORLD/asiapcf/11/24/china.milk.execution/index.html?eref=igoogle_cnn

As though this seems like a harsh penalty, in July, 2007, the Head of China's "FDA" was executed for corruption. The government proclaimed that "Zheng's dereliction of duty has undermined the efficiency of China's drug monitoring and supervision, endangered public life and health and has had a very negative social impact."

http://www.drugresearcher.com/Research-management/China-carries-out-execution-on-corrupt-drug-official


Washington, are you listening?

Don't Even THINK About Releasing That Thanksgiving Mylar Balloon

TALLAHASSEE, FL -- A warning to those who may want to release balloons outdoors: not only is it against the law, but it can harm wildlife.
The Florida Fish and Wildlife Conservation Commission is reminding residents that a little-known law prohibits releasing more than nine lighter-than-air balloons in a day.
Wildlife, especially sea turtles, mistake balloons for food. Plus, strings attached to balloons can entangle birds and other animals.
It's a $250 fine for a violation. There are some exceptions, including scientific or meteorological balloons released by a governmental agency or under a governmental contract.

I've Heard About Beating a Dead Horse, But Beating a Dead Human?? C'mon, Now!!

I often host visiting pharmacy students from other countries. I quickly learned how idiomatic the English language can be. For example, after making the same point several times, I said "I feel like I am beating a dead horse." Imagine the looks I got when the group took me literally.

Well, here is a story where the horse wasn't a horse, but instead a human. And it was not just a silly slang expression.

It seems that in Uganda, people have died from drinking illegally manufacturered gin. As though the loss of life wasn't indigent enough, the government suggests that the bodies be beaten with a stick. Why? To find out, read the full Associated Press story here:

http://news.yahoo.com/s/ap/20091114/ap_on_re_af/af_uganda_caning

Note the unusual ending paragraph: "In Uganda, the bodies of those who commit suicide are also caned as a form of dishonor and to warn against such behavior for the living."

I thought they were going to assert that the caning is a deterrent for the deceased to think twice before they kill themselves in the next life."

Prof. Doering Squares Off On Medical Marijuana Debate on Live TV: You Tell me: Which One of Us is NORML?

You Heard It Right: Your own Professor Doering was called to appear live on a MSNBC show about health matters hosted by Dr. Nancy Snyderman. With little to no time to prepare, I probably had that same "Deer in the Headlights" look so familiar to the PTX students.

Incidently, I was sitting in a very small studio hidden in the bowels of the West stands of The Swamp. I appeared by satellite link.

If I were grading myelf I would count points off for unpressional dress!! When I got up yesterday morning who would have known that I would be asked to appear. At least I was clean shaven!!

These are the AP Writers Speaking, Not Me!

Ah, the wisdom of Homer Simpson. We are often the listeners who must accept published literature to be done correctly and reported honestly. I am not going to editorialize, but rather refer you to the original article. If these allegations are true, the medical literature has been dealt a massive blow.

http://www.msnbc.msn.com/id/33867108/ns/health-more_health_news/

Drink Responsibly-- What Does That Really Mean?

Advertisements for alcohol products invariably manage to sneak in the disclaimer, "Drink Responsibly." Recently, I lectured to a group of high schoolers and we began to analyze exactly what that means. Bless their pointed little heads, one of them said, "It means that if you get drunk and hurt someone, you are responsible."

Irresponsible drinking is nothing new. I suppose Bacchus himself found a way to do wine keg stands or shotgun a cheap Chianti. The electronic age, however, has taken this to a new level. All you have to do is search YouTube and you will find all kinds of irresponsible ways to use alcohol, including vodka enemas, snorting vodka, drinking flaming shots, etc.

This video I found very interesting. It is well made and particularly clear with its step-by-step approach to shotgunning beer. It is interesting that they give their own disclaimers:

1. Drinking beer quickly can get you intoxicated faster. Drink Responsibly

2. Drinking beer this way can be extremely dangerous. The beer will be forced into the throat under pressure. If the beer isn't swallowed fast enough it will be aspirated into the lungs resulting in extreme choking or possibly death due to what is known as a dry drowning.

3. Be careful when putting your mouth on the opening you cut in the can. It can be very sharp and cut you if you're not careful.

Kinda makes me want to run right out and buy a six-pack of diet coke and give it a try!

Remeber, don't try this at home, kids. You could get hurt!

Placebo- (L) verb- I Shall Please

Placebo. A word we hear all the time in pharmacy. I saw a jogger the other day, running alone and wearing a T-Shirt with an arrow pointing to his running partner, and the inscription on his shirt read: "I'm With Placebo."
A second look confirmed that he appeared to be runnning alone. For a microsecond I didn't get it, but as my car passed him, I began to howl with laughter.

While placebo is generally considered a research tool--"this drug performed significantly better than placebo"-- many believe that the effects of certain popular marketed drugs work soley through a placebo effect.

A recent Associated Press article blared the following headline:

Experts: Placebo power behind many natural cures
http://www.google.com/hostednews/ap/article/ALeqM5g2gbCpUe6MuJCcaBJ_YDq138cjHwD9BSQS200

While I don't discount their findings, it does raise one question: so what if it is by placebo effect that people feel better? At least they feel better. Problem is, research estimates that only 1 in 3 persons will experience a placebo effect. What about the other 2 people?

A really cool study was done whereby they pitted one placebo against another. They called the second one "nocebo." The results are fascinating. Read it at: http://ehp.sagepub.com/cgi/reprint/29/4/394

So next time you get a 'script for Obecalp, remember all that is is Placebo spelled backwards!

It's enough to give you a headache. I think I'll go take a placebo!

An Alternative Use for Your Lab Coats

In Brazil, a student was expelled for wearing her mini-skit too short. Here are the opening lines of an article on the subject:

A Brazilian university has expelled a woman who was heckled by hundreds of fellow students for wearing a short, pink dress to class – publicly accusing her Sunday of immorality.
The private Bandeirante University in Sao Bernardo do Campo, outside Sao Paulo, said 20-year-old Geisy Arruda disrespected "ethical principles, academic dignity and morality."

More important, after a conference with university officials, she was escorted off the campuys in a haute couture lab coat quite similar to the ones you all wear. Let's hope we don't need to use them for this dubious purpose.

The following clip in is Portuguese. I think it is rated PG, but I don't (necessarily) take blame for any objectionable language:

Sleep Apnea: Not Worth Losing Sleep Over (Or Your Life For That Matter)

In Main Case #5 one of the possible diagnoses for Neal Beal was sleep apnea. We atlked a little bit about it in class, and I encouraged Dr. Anderson to pursue some line of questioning around this subject. Why, you ask? Because I HAVE it!.

Some of you toyed with the idea of prescribing CPAP for Neal. This is a good idea on a chronic basis. I am not if it fits in to the current treatment plan.

In case you have never seen the apparatus, I asked my wife to shoot this photo of me sound asleep. I know it is not a pretty sight.

If you have any questions about this "space age" look I would be happy to answer them. At least I know I won't be falling asleep at my desk by 2 PM like I used to.

In the Spirit of Quality Improvement: The Correct Way To Gouge Eyes

Much has been said about an alleged incident involving a Florida Gator football player trying to gouge out the eyes of an opposing player. In the EBP course, we are embarking on a new discussion: Quality Improvement in Health care.

You may not know that these principles are not restricted to the Health Care Industry. Yes, that's right: in our everyday world we can applytechniques shown to improve health care outcomes to, let's just say, eye gouging.

One of the first steps in the QA process is to do a thorough review of the literature. We must try to find others who have faced the same problem and have made progress towards its solution. Follow this link to see some pointers on how this should be done:

Saudia Arabian Court Orders Eye to Be Gouged Out

http://www.hrw.org/en/news/2005/12/08/saudi-arabia-court-orders-eye-be-gouged-out

Please note that this punishment was ordered for a migrant worker for his part in a brawl. Do you see the parallel: Football? Brawl? Check it out.

Speaking of Supplements: Score One for the FDA

How timely!! No sooner did I post the Mel Gibson bit than I got a message from the FDA announcing that, as part of its ongoing cooperation with the Food and Drug Administration ("FDA"), Bodybuilding.com, LLC announced today that it is conducting a voluntary nationwide and international recall of all lots and expiration dates of 65 dietary supplement products described in a list, that were sold through the Company's website, http://bodybuilding.com

It appears to me that the FDA is serious about cleaning up the Sports Supplement Industry. Check out the rest of the article at:

http://www.fda.gov/Safety/Recalls/ucm188929.htm

DSHEA: Should We Thank or Blame Mel Gibson?

Some of you have heard me proclaim over the years that in my opinion, the Dietary Supplement Health and Education Act of 1994 was the most ill advised piece of federal legislation since the Stamp Act. Support was garnered for passage of this legislation by some very scary commercials portraying what the world would be like if DSHEA was not passed. Sit back an watch as one of your favorite actors "shills" for the Supplement Lobby.

Officer, Somebody Stole My Weed!!

Gainesville Sun Headlines: Gainesville man reports robbers took his marijuana

Here's the body of the article from The Sun on Tuesday, November 3, 2009:

A Gainesville man called several neighbors and friends before calling 911 to report that someone had stolen a few grams of his personal marijuana stash.

Von Powell, 22, told Alachua County deputies that the robbery happened at 2:45 a.m. while he was home alone in his apartment in the 7000 block of Southwest 44th Avenue. According to sheriff's spokesman Art Forgey, Powell claimed he was sitting on his coach, listening to music, drinking a beer and smoking a blunt [a marijuana cigarette] when two men kicked in the front door of the apartment.

"He told us that one of the men hit him on the head with a chrome firearm and that they took cash from his pocket and three to four grams of his personal smoking weed," Forgey said.
Powell said he ran out of the apartment and so did his attackers. He said he saw them get into a dark-colored vehicle and drive away.

"Then he waited 45 minutes to call 911," Forgey said. Powell spent the time calling his neighbors and a few friends to tell them what had happened to him.

No arrests had been made in the case by Tuesday.

Anybody Seen My Alligator?

I've heard of people losing their keys or misplacing their glasses. I've heard of people losing thier a** in Las Vegas. But this one takes the cake. Read the Associated Press artcile that appeared a few days ago:

PANAMA CITY BEACH, Fla. (AP) — Officials believe they have located an alligator that escaped after a Florida Fish and Wildlife officer brought the animal to his daughter’s school for show and tell. FWC spokesman Stan Kirkland says officials think the 5-foot alligator is in a Panhandle pond. Authorities weren’t able to capture the critter Friday. Searchers scoured a wooded area surrounding the school Friday afternoon after the alligator jumped out of the man’s vehicle with it’s mouth taped shut. Kirkland says he heard the schoolchildren were “impressed” with the demonstration.

This photo was taken between the Fall Semester of 2005 and the Spring Semester of 2006. I think I told you who is inside the costume. It is a violation of the University's Athletic Association Policy to reveal this secret. E-mail me if you are not sure!!

Welcome to Wal-Mart: Bargains to Die For!

(ChattahBox)—The giant retailer Wal-Mart, is now offering its customers the opportunity to purchase caskets and urns online, for a cheaper cost than offered at funeral homes. The caskets would be shipped within 48-hours and customers have the option to “plan ahead,” paying for the casket over a 12-month period.
Walmart is not the first retailer to sell caskets and other funeral items online. The large discounter Costco already sells caskets online, and Overstock.com and Sam’s Club sell burial items, as well.
The caskets and other funeral items, come from McHenry, Ill based Star Legacy Funeral Network, Inc., which also supplies products to Costco.
Walmart casket prices range from $895 for the “Dad Remembered” and “Mom Remembered” steel caskets to $2,899 for the upscale Sienna Bronze Casket. Caskets at funeral homes can reach $5,000 or more.
Federal law requires funeral homes to accept outside caskets.
Walmart spokesman Ravi Jariwala said “Several online retailers offer this category on their sites. We are simply conducting a limited beta test to understand customer response.”

If you are in need of such an item or if you simply want to be ready when the time comes, click this link:

http://www.walmart.com/search/search-ng.do?search_constraint=0&ic=48_0&search_query=caskets

I am sure they have one that will fit your needs for sytle and comfort!!

Package Inserts: Do They Serve Their Function?

Here's the latest headline from the Associated Press: Drug safety experts urge FDA to make drug safety info more accessible to patients.

Here's the opening paragraph to their story: Did you know that Lunesta will help you fall asleep just 15 minutes faster? Or that a higher dose of the osteoporosis drug Zometa could damage a cancer patent's kidneys and raise their risk of death?

Only by wading through the FDA's 403-page internal review of Lunesta do the details emerge: patients fell asleep 15 minutes faster and slept 37 minutes longer, on average.

In a scathing editorial in this week's New England Journal of Medicine, drug safety experts Drs. Lisa Schwartz and Steven Woloshin claim much of what the Food and Drug Administration knows about a drug's safety and effectiveness is not included on the label. Remember, the use of the term "label" in this context is not the label on the prescription vial, but the official labeling, a.k.a. the package inert.

The title of the Editorial is: Lost in Transmission — FDA Drug Information That Never Reaches Clinicians. It can be accessed at: http://healthcarereform.nejm.org/?p=2126&query=home

To read the "spin" on this article check out the full AP story:

http://www.chicagotribune.com/health/sns-ap-us-fda-drug-labels,0,2241045.story

Failure to Adopt Heart Failure Guidelines

Throughout this semester and previously in your curriculum we have shoved down your throats the importance of following clinical guidelines in the practice of medicine or pharmacy. What we haven't emphasized so much is the fact that, even when clinical guidelines have been fully endorsed and become the "standard of care," physicians can be slow to implement the guidelines.

An article in today's JAMA shows this to be the case with Heart Failure Guidelines. Watch this very short video released by JAMA. If you are captivated by this idea, then you may wish to read the entire paper: http://jama.ama-assn.org/cgi/reprint/302/15/1658

Also, here is an article by the Associated Press commenting on the published study :
http://www.google.com/hostednews/ap/article/ALeqM5gR2huSp8_aCl-iSQtwd11mCrUxDwD9BF1DU03

Can I Be Blunt With You?

Many of you have studied the various drug delivery systems on the market. These include tablets, capsules, suspensions, emulsions, enemas, creams, and ointments. As you know, inhaled drugs are rapidly absorbed and produce high blood levels quite quickly.

In case you don't already know it, cigars can make a great matrix for drug delivery. Called Blunts (named after the type of cigar used), this dosage form is gaining wide acceptance, especially in places like California.

To learn more about this curious drug delivery system, watch the following short video:



Freedom of Speech: Isn't it wonderful?

The Correct Position for Defacation

In case you care to know, there is a right way and a wrong way to go to the bathroom. The Figure at the left comes from a recent article published in BMJ.

I hope the apparatus under his feet is firmly planted on the ground. Otherwise, he would have a "loose stool."

For more information on this article you may want to click on the following link:
http://www.bmj.com/cgi/section_pdf/338/mar20_1/b831.pdf

And, no, I'm not kidding. This is a real article in the medical literature.
(Thanks go to David Angaran for bringing this landmark research to the attention of the faculty).

Does Giving Tylenol Reduce Efectiveness of Vaccines?

Just when you thought you had figured out what to do about the flu vaccines, along comes a study that muddies the waters even more. It seems that a new study published in Lancet shows that giving acetaminophen after certain vaccines undermines the immunologic response that gives protection in the first place. Here are the details:




Acetaminophen May Weaken Effectiveness of Kids' Vaccines
Giving analgesic to prevent fever at shot time could be counterproductive, researchers say.

by Steven Reinberg HealthDay Reporter

THURSDAY, Oct. 15 (HealthDay News) -- Fever after a vaccination is a normal and essential part of building an immune response, and giving children acetaminophen -- best known in the U.S. as Tylenol -- after a shot could dampen that response, a new study finds. With some vaccines, transient fever means that a child's immune system is processing the immunization, providing them with the best protection, explained Dr. Robert T. Chen, a blood safety specialist at the U.S. Centers for Disease Control and Prevention.

Therefore, "unless your doctor specifically recommends it, do not administer fever-reducing medicines at the same time as vaccination to prevent your child from developing a fever," said Chen, who wrote an editorial accompanying a report in the Oct. 17 issue of The Lancet.

"It is still okay to use antipyretics [acetaminophen or ibuprofen] to treat a fever, but just not recommended to prevent fever," he added. "High fevers can be serious, especially in infants. It is important to work with your doctor to provide the best care for your child."

For the study, a research team led by Dr. Roman Prymula, from the University of Defence in Hradec Kralove, Czech Republic, did two studies, one when children received their first vaccination and another when they received their booster shot.

The vaccinations were routine for protection against pneumococcal disease, Haemophilus influenzae type b (Hib), diphtheria, tetanus, whooping cough, hepatitis B, polio and rotavirus.
The 459 infants in the studies were randomly assigned to get acetaminophen every six to eight hours for 24 hours after vaccination or no acetaminophen.

Prymula's team found that fewer infants who received acetaminophen had a fever, but these babies also had significantly fewer antibodies against pneumococcal disease, Haemophilus influenzae type b, diphtheria and tetanus toxoids, and for one of the whooping cough antibodies compared with infants who did not get acetaminophen.

They believe the pain reliever's anti-inflammatory activity might trigger "interference" to healthy immune system antibody responses, explaining the weakened immunization.
"Unless there are specific reasons for controlling fever, for example, in a child with history of febrile convulsions, Tylenol and other fever reducers should not be routinely given along with immunizations," Chen said.

Infectious disease expert Dr. Marc Siegel, an associate professor of medicine at New York University School of Medicine in New York City, said that "the conclusion that Tylenol not only suppresses fever, but also decreases immune response is plausible. After all, what is an immune response? It's an inflammatory response."

Siegel agrees that acetaminophen should not be routinely given to infants to prevent fever after vaccination. "But, if the kid is sick, treat the sickness. If the kid is very sick, I would get the fever down," he said.

And what about the vaccine for the H1N1 flu? According to Siegel, "giving an infant Tylenol before an H1N1 flu vaccine shot may not be a problem, because the immune response to the vaccine has been so robust."

Here is a news pience from Fox News:

Police in Pa. Arrest Pothead--Literally!!

A number of years ago there was an anti-drug campaign centered around the catch phrase "Why do you think they call it dope." Well, here is a partial answer. This article appeared as an Associated Press wire story and was picked up by media outlets all of the country and around the world:

"A police officer arrested a man in a convenience store in the US after noticing a bag of marijuana stuck to his forehead.

The 29-year-old was spotted walking away from the toilets of the shop in Lebanon, Pennsylvania, looking anxiously at the inside of his baseball cap. When the man approached the officer, he looked up, and the officer noticed a small plastic bag stuck to his forehead that appeared to contain marijuana.

The officer retrieved the bag from the man's forehead and asked, "Is this what you're looking for?", a police news release states.

The man, identified as Cesar Lopez, was charged with possession of a small amount of marijuana and possession of drug paraphernalia, police said. Police said it is not uncommon for people to store drugs inside the sweatband of baseball caps."

Now you know why it's called DOPE!

Behind Bars and Looking at a Real Long Stretch

I missed class on September 25th because I was in Pensacola testifying against the doctor described below. My FBI friend told me it was a pathetic scene when he was remanded into custody right there in the courtroom. The US Marshals put on the cuffs, frisked him, made him remove his belt and watch and other such things, empty his pockets, but here is the best part: they made him surrender his toupee!!
One of the counts involved a death and they tell me that this carries a minimum mandatory sentence of 20 years. For him, that's a life sentence.


PENSACOLA — Destin physician Dr. David W. Webb was convicted Wednesday of 130 of the 131 charges federal agents brought against him in January. Amy Hunt, spokeswoman for the U.S. Attorney’s Office in Pensacola, confirmed that Webb’s conviction on one charge of a drug distribution makes him liable for four patient deaths. “It’s a relief. It’s well deserved. I’m glad to see justice was served,” said Deb Morrison, who said she went to authorities after the 2005 death of 21-year-old Anthony Moore, who she described as “my son’s best friend.” Webb, 67, and his wife, Bonnie Webb, were charged with 36 counts of health care fraud and 79 counts of illegally dispensing drugs. They also were charged with identity theft, conspiracy and the drug distribution charge involving the four deaths. Webb also was charged with making fraudulent health care benefit claims for patients another physician was seeing. Bonnie Webb, 57, who worked as her husband’s office manager, previously had pleaded guilty to the charges she faced. She is scheduled for sentencing Oct. 13. Hunt could not provide a sentencing date for David Webb. The Webbs operated the Doctors on Call clinic. Their arrests followed the seizure of 14,000 patient records. Prosecutors said at the time of the arrest that Webb had been prescribing drugs in high dosages and helping “doctor-shopping” patients abuse them. Webb was a longtime Destin physician who made house calls. Reports following his arrest said he had been under federal scrutiny for years. Federal agents had conducted an extensive review of Webb’s files in 2006, going through seven years’ worth of business and 100,000 office visits. As far back as 2005, Webb’s medical license was suspended for prescribing Viagra, Xenical and other drugs based solely on Internet order forms, according to a report. Prosecutors say he continued prescribing drugs during his suspension by using another doctor’s Drug Enforcement Agency registration number to conceal it.

Who Is This Pharmacist On the Cover of Florida Pharmacy Today?

I am sure that many of you know Dr. Karen Whalen, Clinical Associate Professor and Assistant Campus Director at our St. Pete campus. I'll bet some of you DON'T KNOW that Karen is the Current President of the Florida Pharmacy Association. As such, she has the privilege of representing all of us pharmacists in the state, and for this I am personally very proud!

Here is her bio as it appears on the UF web site:

Dr. Karen Whalen joined the faculty as Clinical Associate Professor and Assistant Director of the St. Petersburg Campus in August 2008. Dr. Whalen received her Doctor of Pharmacy degree from the University of Florida. She then completed a Pharmacy Practice Residency at the Moses Cone Health System in Greensboro, North Carolina. Subsequently, she completed a Primary Care Residency at the James A. Haley Veterans’ Hospital in Tampa, Florida. Prior to joining the faculty at University of Florida, Dr. Whalen was an Associate Professor of Pharmacy Practice at Nova Southeastern University for twelve years. Dr. Whalen is a Board Certified Pharmacotherapy Specialist and a Certified Diabetes Educator. She maintains an active ambulatory care practice site with the Bay Pines VA Healthcare System. Dr. Whalen is an active member of the Florida Pharmacy Association, and currently serves as President of that organization.

I point this out for several reasons:
1. I am very proud that a fellow-faculty member has been entrusted to represent ALL pharmacists in the stae, regardless of practice venue,
2. She has found the time to serve despite the demands of her faculty position and family matters,
3. She is a UF grad and a former student of mine, and,
5. She is an extremely capable person who is a perfect role model for our pharmacists of the future.

You may also be interested to know that Dr. William Riffee, Professor and Dean of the College of Pharmacy, was elected "Speaker-elect " of the FPA.

As if that wasn't enough, Dr. Carol Motycka, Clinical Assistant Professor and Assistant Dean and Director of the Jacksonville Campus, was elected Chair of the Education Council of the Florida
Pharmacy Association (FPA) at the annual meeting of the FPA in St Augustine. Carol is also President-Elect of the Duval Co Pharmacy Association.

Oh, and lest I forget, it just so happens that the current president of the American Pharmacists Association is a Gator graduate and long time college supporter. Ed L. Hamilton, PharmD, FAPhA Director of Pharmacy at the Regency Medical Center in Winter Haven, Florida, was installed as President of the American Pharmacists Association (APHA) at the closing session of the association’s 157th Annual Meeting & Exposition in San Antonio, Texas, April 6, 2009.

There are Gator Pharmacists everywhere. Will you be the next one?

Tips From Doering's Drug Information Tool Box

For over 28 years I served as either Director or Co-Director of the Drug Information and Pharmacy Resource Center. This center, established in February of 1972, has answered countless questions from Health Professionals around the state and around the nation.

Throughout this time I have learned a lot of what could be called "tricks of the trade" to make the job of answering tough questions easier.

I would be dishonest if I said I don't miss those times, talking with fellow pharmacists from all corners of our state and helping them solve patient-specific questions arising in their practices. I dearly miss talking with nurses, physicians, dentists, and virtually all other types of Health Professionals.

You have heard me many times confess that I am not the sharpest knife in the drawer, but I have learned how to find answers to even the most difficult questions. Thus, I am starting this new feature called "Tips From Doering's Drug Information Tool Box." Here is the first installment:

Black Box Warnings: What is their purpose? Who decides what goes in there? And most important, where can I find a comprehensive list of Black Box Warnings?

I'm going to let you struggle with the first two questions, but I suggest you check out the following web site for a list of the latest warnings. As you may know, increasingly the FDA is using this mechanism to convey important safety information about drugs. BBW's are a BIG DEAL. Check the out here:

http://www.formularyproductions.com/blackbox/

It's That Time of Year Again

It's hard to believe that a year has passed since Darth Vader made a surprise appearance in our Phamacotherapy IV Class. Rumor has it that a movie is coming out capturing the drama and intensity of that moment in October of 2008.

There's no telling who might show up this year.

A Touching Article Written by a 4PD Clerkship Student

On The Shoulders of Giants
by Jena Koshaish, 4PD Student, St. Pete Campus

It’s 7:55 am and I’m checking a random vancomycin level from one of my patients drawn earlier this morning. The level is 25.5; darn, we over shot! But it’ll be ok because they have pneumonia and acute respiratory failure, we’ll need troughs around 20 to be aggressive. I’ll have to see them first and figure out what happened. I ask myself:

•Are they still on pressors (norepinephrine, vasopressin)?
•They came in septic, how is their renal function?
•What is their urine output?
•Did we draw cultures?
•Is this still empiric therapy or are we dealing with MRSA?

These are just a few of the questions I’ve been trained to ask in the intensive care unit at Lakeland Regional Medical Center.


Working the ICU is one of the most exciting places in the hospital. Usually patients are on several medications, titrated to keep the patient as hemodynamically stable and comfortable as possible while their body recovers from the trauma or illness. Pharmacists play a key role in the ICU by titrating pain and sedation medications, dosing antibiotics, optimizing blood glucose control, renally adjusting medications, monitoring therapeutic outcomes, choosing appropriate therapy for a given patient, ensuring that evidenced based medicine is practiced by referring to guidelines and primary literature to resolve questions, and as a medication expert for nurses and physicians.

During my rotation I had the privilege to work with three amazing critical care pharmacists who pushed me each and every day to expand my knowledge of the commonly used drugs in the ICU. On my first day of the rotation I assisted with CPR during a code. As I walked into the dimly lit room, the patient’s family members were standing in the corner of the room with tears welling in their eyes as their grandmother/mother was dying right in front of them. The patient was intubated and the nurse had already begun chest compressions when I entered the room. My preceptor asked if I was comfortable giving chest compressions, I nodded yes. He took my white coat and I walk toward the patient’s bed. The nurse asked me if I was ready. I thought, ready as I’ll ever be. But I just nodded yes.

She stopped compressions and I quickly aligned my hands, one on top of the other, over the patient’s chest. As I pushed down on her chest, I heard the tubing of the ventilator crackling in her bronchioles and blood was coming up from the ET tube. It was the scariest thing I’ve ever done. After about a minute and a half I asked my preceptor if I could be relieved. Shortly thereafter the physician came into the room with another family member and told us to hold CPR; the patient’s family had signed the DNR. The nurse took her hands off the patient’s chest, the ventilator and pumps were turned off, and most of the staff in the room left. I washed my hands, put my coat back on and followed my preceptor out of the room. It was perhaps the saddest, most thrilling thing I’ve ever witnessed. From then on I knew this would be a very different rotation, but most of all it would be the best rotation I’ve had so far.

Drunk or Not-Drunk? You be the Judge

At one time or another you have probably seen somebody stopped by the side of the road, performing field sobriety exercises. While many times the results are subtle and inconclusive, this case is a "no-brainer." Watch the short clip and you'll see why I call it a no-brainer.

Thanks to Dr. Derendorf for bringing this to my attention.

Crack Discovered at Crystal River Power Plant

OMG! Don't tell me that the operators of this nukie plant were found with Crack Cocaine? Oops. Should have read farther. They found a a crack in the concrete of the containment building of the Crystal River nuclear power plant, owned by Progress Energy.

Whew!!

If you want to read the whole story, here it is:
http://www.gainesville.com/article/20091009/ARTICLES/910089868

"Just Spit." Test Detects Patients Who Don't Respond to Plavix

We have had a lot of discussion of the practical uses of pharmacogenomics. I think it is reasonable to say that the practical applications of this field of study are still emerging. The Associated Press reports that there is now a new way to determne patients' responses to Plavix.

Here's their report:

WASHINGTON -- "Just spit." With those simple instructions, health care providers in California are hoping to expand the use of genetic testing to make sure patients get the right medication.
Scripps Health hospital system has begun using a saliva-based genetic test to detect whether patients will respond to Plavix, a widely used blood thinner that usually prevents clots.
But recent studies show about one-third of people of European descent, and more than 40 percent of people of African and Asian descent don't properly respond to Plavix, putting them at increased risk of fatalblood clots. The new laboratory test from Quest Diagnostics detects four genetic mutations found in more than 90 percent of patients who won't benefit from the drug, which is marketed byBristol-Myers-Squibb andSanofi-Aventis. While older tests were capable of picking up the mutations, Quest says its test is the first designed for routine use and quick processing.
"It's so much simpler for patients because they don't have to undergo a blood draw, and that makes the process much more convenient for everyone involved," said Dr. Eric Topol, chief academic officer of Scripps Health.

It Took Only Two Weeks For "The Sign" to Go Up!!

Dear Pharmacy Students,
Please read below the message from the University Policy Department regarding using trees in the Health Center Courtyard to park bicycles. Please adhere to this policy and save yourself money and aggravation in reclaiming your bicycle if you choose to disobey this request. Let's not harm the trees by locking bicycles to them. There are bicycle racks around the health science center that can be utilized and which may require you to walk further into the Health Science Center than a bicycle ride to the courtyard affords.
Thank you for your cooperation with this policy.
Sincerely,
Dr. McKenzie

"An officer from UPD came in yesterday and asked that I generate an email to all of the college's students letting them know that it is not alright to lock their bikes to the trees in our courtyard. He said there's been a real issue with this lately and that it's not only unattractive, it's hurting the trees. He wanted to warn the students that if it continues, they will get ticketed or their bikes will be removed from the trees."

I told you so!!

Stuck Between "Botox" and "Toe Rings......"

On a recent trip to Los Angeles, Dr. Christian Hampp (notice: Hampp not Hemp), who recently received his Ph.D. from our College, snapped this photo of a "pharmacy" specializing in herbal medicines. Notice the juxtaposition of this shop, smack dab between a Botox Boutique and a Toe Ring Emporium. Christian makes this insightful observation: "I'm sure they do some serious medical research there..."

I wonder what the criteria are for dispensing the MJ. according to this "evaluation center." I suppose a wallet biopsy is part of the process.

Only in California.......

I Have "Inherited" $12 Million; I Feel so Lucky!

Wowee, I'm Rich. Read the e-mail below and see how I have instantly become a millionaire. I feel so fortunate!! I may just be able to retire early!!

E-Mail receive 10/6/09:
Good Day,
I found your contact particulars in an E-mail address guide they provide us here, as I desperately need an urgent help to do this deal. I am seeking your kind assistance to move the sum of $12m {Twelve Million U.S Dollars only} to you in United States , as far as I can be assured that my share will be safe in your care until I complete my service here.

SOURCE OF FUND:

A lot of money in various currencies were discovered in barrels at a farm house near one of Saddams old palaces in Tikrit in Iraq during an operation Conquest in Fallujah north of Baghdad, and it was agreed by Staff Sgt. Kenneth Buff that some part of this money be shared among both of us before informing anybody about it since both of us saw the money first. This is quite an illegal thing to do, but well tell you what? no compensation can make up for the risk we have taken with our lives in this hell hole, of which my brother in-law was killed by a road side bomb last time.
The above figure was given to me as my share, and to conceal this kind of money became a problem for me, so with the help of a British Contact working here, at Southern Basra British fortified green zone, whose office enjoys some immunity, I was able to get the package out to a safe location entirely out of trouble spot. He does not know the real contents of the package, and believes that it belongs to a British/American medical doctor who died in a raid here in Baghdad, and before giving up, trusted me to hand over the package to his family in United States . I have now found a very secured way of getting the package out of Iraq to you, for you to pick it up, and I will discuss this with you when I am sure that you are willing to assist me, and I believe this my money will be well secured in your hand because you have a fear of God.
I want you to tell me how much you will take from this money for the assistance you will give me. One passionate appeal I will make to you is not to discuss this matter with anybody, should you have reasons to reject this offer, please and please destroy this message as any leakage of this information will be too bad and catastrophic for soldiers here in Iraq. I do not know how long we will remain here, but I hope to have a shift very soon for me to return back to the States. I have been shot and wounded twice and I have survived two terrible suicides bomb attacks just by special grace of God, this and other reasons I will mention later has prompted me to reach out for help, I will honestly want this matter be resolved immediately. You can contact me at sgtedwincurt@gmail.com
I thank you so much for everything and anticipate that you will be trustworthy and handle this transaction to the best of your ability to benefit both of us.Conatct me through my private email at sgtedwincurt@gmail.com
God Bless you and your Family.
Yours
Sgt. Edwin Curt

Would You Like Some Cocaine Vaccine to Go Along with that H1N1?

Yep, it's true. Researchers have had some limited success in teating cocaine addiction by using a vaccine.

Scientists say they have developed a cocaine vaccine that can prevent addicts from getting high by blocking the drug’s effect on the brain, though it does not blunt cravings for the drug.

A New York Times article states that "the trial’s success is significant because some of the same principles are being used by other scientists in trying to create an antinicotine vaccine, which could have even broader appeal."

http://www.nytimes.com/2009/10/06/health/research/06cocaine.html?scp=1&sq=%2b%22Food+and+Drug+Administration%22&st=nyt

If you're interested in reading the entire paper, here is a link:

http://archpsyc.ama-assn.org/cgi/content/full/66/10/1116

Should the Color of Nasal Discharge Dictate the Medicine?

We've all been taught that a thick, green-colored nasal discharge is a sure sign of bacterial infection. In fact, practitioners use this to determine if antibiotics are appropriate.

Every now and then new information comes along that calls into question these long-held notions. A recent article in the New York times reveals that the color of the discharge may be misleading.

A line from the story reminds us that "Old prescription habits apparently die hard."

Click on this link to find out more:

http://www.nytimes.com/2009/10/06/health/06real.html?emc=tnt&tntemail1=y

Will You Have a Job When You Graduate??

This just in from the Associated Press:

Panasonic said Tuesday it has developed a medical robot that dispenses drugs to patients, the Japanese electronics giant's first step into robotics.

Panasonic will sell the robot to Japanese hospitals next March and will market it in the United States and Europe later.
Panasonic spokesman Akira Kadota said the robot will cost several tens of millions of yen (hundreds of thousands of dollars).
"This robot is the first in our robotics project. It sorts out injection drugs to patients, saving time for pharmacists," said Kadota.
The robot does not look humanoid. "It looks like a cabinet with lots of small drawers," he said.
Pharmacists put drugs into the robot, which stores medical data for patients. The robot will then sort out drugs for each patient and place them into respective drawers bearing the names of patients.
Osaka-based Panasonic hopes annual revenue from the robot and other medical robotics will reach 30 billion yen ($315 million) in the financial year to March 2016.
Japan boasts one of the leading robotics industries in the world, and the government is pushing to develop the industry as a road to growth. Automaker Honda Motor Co. has developed the child-sized Asimo, which can walk and talk.
Earlier this year, the National Institute of Advanced Industrial Science and Technology, a government-backed organization, revealed a walking, talking robot with a female face. But it hasn't cleared safety standards and cannot yet help humans with daily chores.

Joke: The Hypnotist at the Senior Center (Rated R- language)

As the hypnotist went to the front of the meeting room at the senior center, he announced,'Unlike most hypnotists who invite two or three people up here to be put into a trance, I intend to hypnotize each and every member of the audience.'
The excitement was almost electric as the hypnotist withdrew a beautiful antique pocket watch from his coat.
'I want you each to keep your eye on this antique watch. It's a very special watch. It's been in my family for six generations.'
He began to swing the watch gently back and forth while quietly chanting,
'Watch the watch, watch the watch, watch the watch ...'
The crowd of seniors became mesmerized as the watch swayed back and forth, light gleaming off its polished surface.
Hundreds of pairs of eyes followed the swaying watch, until, suddenly, it slipped from the hypnotist's fingers and fell to the floor, breaking into a hundred pieces.
'Shit,' said the Hypnotist.
It took THREE DAYS to clean up the senior center.