Tucson clinical pharmacist does primary diabetes care
Aug27

Tucson clinical pharmacist does primary diabetes care

Those of you who do chemistry in colleges of pharmacy are used to discussions of how your graduates can truly use their Doctor of Pharmacy training. You've probably often wondered why your students spend so much time in clinical pharmacy when more than half of them end up in community pharmacy, a model that has largely kept its sweatshop-like workflow (the "counseling booth" at my local pharmacy has cobwebs for the simple reason that pharmacists cannot be reimbursed for cognitive services.) Well, I want to bring you a story of how pharmacists can contribute to primary care when in a regulatory environment that makes it possible. The Downtown Tucsonan tells the story of clinical pharmacist, Sandra Leal, a valedictorian graduate of the University of Colorado School of Pharmacy (Disclosure: Sandra was an American Cancer Society supported undergraduate in my laboratory while she was at the University of Arizona who we then recruited to Colorado for her PharmD.) As the first pharmacist in Arizona to earn limited drug prescribing authority, Sandra works in a team-based community practice environment. At El Rio Community Health Center, clinical pharmacists primarily manage long-term care of patients with diabetes while physicians can then work on the more involved acute cases. But the concept didn't come from a shiny new college of pharmacy with dozens of clinical faculty members. This revolutionary idea of clinical pharmacists working directly with patients is run-of-the-mill medicine south of the border. Leal learned this while growing up in Nogales, Ariz. “My parents didn’t speak English,” Leal said. “We always went to Mexico for health care. You walked into the pharmacy and could get treatment. To me, that was primary care. The pharmacist was my doctor growing up. I never considered any other field. I made a decision in high school that I would be a pharmacist.” You can read more about Leal's community practice model at the Downtown Tucsonan. You can also learn more about Sandra from a 2009 interview we did back at the old home of Terra Sigillata. The post was part of the Diversity in Science blog carnival during Hispanic Heritage...

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Vicks VapoRub PR Fail
Oct10

Vicks VapoRub PR Fail

I have to say that this whole episode is worth seeing editor and medical journalist, Ivan Oransky, MD, in a snuggie. I can't match the facts: Dr. Oransky reveals a promo-pak he received from the PR firm representing Vicks VapoRub contains about $400 of merchandise and purchase credits, but NO BLOODY VAPORUB!!! Ethics and all aside, I'm quite disappointed that the PR firm charged with promoting this traditional folk brand would act against the basic ethical tenets of the Public Relations Society of America. As Ivan notes, it's okay for PR firms to provide a small amount of complimentary product for review purposes but despite the lavish swag, there's no product in his promo-pak! On one hand, I say to Dr. Oransky that he'll be thinking otherwise than sending back his snuggie after the first blast of cold in his out-of-state getaway. On the other hand, I'm equally disheartened that the PR firm has not handled this venerable brand with the reverence deserving of one of the epic pharmacy brands of the American South. To wit, this is what you will find on Elm St in downtown Greensboro, North Carolina, just south of the F. W. Woolworth's site of the 1960 sit-ins by North Carolina A&T State University students.   Vicks VapoRub is an old formula of natural, essential oils that are today comprised of: Camphor 4.8% (Cough suppressant and topical analgesic) Eucalyptus oil 1.2% (Cough suppressant) Menthol 2.6% (Cough suppressant and topical analgesic) Having your Mom or other caregiver rub it on your chest when you had a sinus or chest cold was probably far more effective as a placebo that the product itself. But the compounds do indeed act as vasoconstrictors and bronchodilators when inhaled at their very high concentrations. But after this PR stunt, old pharmacist Richardson has to be turning over in his grave. A Vicks VapoRub snuggie might help. Addendum (October 11): I've now located a more detailed description of the story behind the Lunsford Richardson historical marker from the site of the North Carolina Department of Cultural Resources: Lunsford Richardson, born in 1854 in Johnston County, was educated at the Horner and Graves Academy in Oxford and enrolled at Davidson College in 1872. His mother, who had raised Lunsford and his four siblings alone, died the following year, leaving Richardson with enough money for only three years at Davidson. Richardson graduated from Davidson in 1875—number two in his class and with medals in Greek, Latin, and debating. He served four years as a principal in Cumberland County, but left school to become a pharmacist—one of the only other jobs that he felt would...

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Skin-bleaching: got mercury?
May27

Skin-bleaching: got mercury?

The Minnesota Health Department yesterday issued a warning that skin-lightening cosmetic products sold in the area contain concentrations of inorganic mercury high enough to warrant their disposal as hazardous chemical waste. Details on the warning can be found in this Star Tribune article by Maura Lerner with intern Alejandra Matos (hurray for summer student interns!). State technicians tested 27 products, including 23 creams and four soaps, and found that 11 had mercury levels ranging from 135 to 33,000 parts per million. Federal law permits only "trace amounts," less than 1 part per million. Ramsey County officials said they became suspicious about the lightening creams when a staffer came across a blog about the mercury dangers. The staffer, who worked with immigrant groups, knew the creams were popular among Somalis and others and thought it was worth checking out, said Zachary Hansen, the county's director of environmental health. Skin-lightening creams are popular in African nations as well as in some Asian cultures. A truly excellent 2008 review from a group of clinical dermatologists at the University of Lagos College of Medicine appeared in the International Journal of Dermatology. The authors present therein some of the reasons why dark-skinned individuals might use such products: Some of these are to look more attractive; to go with existing fashion trend; to treat skin blemishes like acne or melasma; to cleanse or “tone” the face and body; or to satisfy the taste of ones spouse. Although the men also use the products for the above reasons, some of them claimed they use the creams because their wives use them; and some male marketers of female cosmetics and toiletries claim they use the products to advertise their wares. Some of the men are homosexuals. The habit of bleaching the skin is most rampant among commercial sex workers who camouflage their occupation in the clinic data as “fashion designer” because of the opprobium attached to prostitution. It is noteworthy that even some people who are naturally fair in complexion, still use the bleaching creams to “maintain” the light skin color and prevent tanning or blotches from sunlight. Currently, the Minnesota warning has not yet been associated with any illnesses or toxicity events. However, mercury-containing skin-lightening creams have been associated with typical, inorganic mercury nephrotic syndromes as early as this 1972 BMJ report from Nairobi where the disease was most commonly seen in "young sophisticated African women." But the risks associated with these skin-bleaching creams are not only due to mercury. More commonly, these products employ hydroquinone (benzene-1,4-diol). A naturally-occurring antiseptic compound - and carcinogenic hepatotoxin - found in the herbal product, uva ursi or bearberry, hydroquinone...

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Synthetic marijuana for pharmacists
Feb24

Synthetic marijuana for pharmacists

As a former pharmacy professor, I'm honored that a couple of our old and new blogposts have been picked up by colleagues at the University of Texas at Austin College of Pharmacy. Clinical Assistant Professor and drug information specialist, Jennifer Seltzer, PharmD, and her intern, Tiffany LaDow, PharmD, included us in their online durg information alert entitled, "'Spice' It Up - A New Way to Get High: What Pharmacists Need to Know." This type of distillation by LaDow and Seltzer is representative of exactly the kinds of briefs I used to enjoy writing for the Colorado Pharmacists' Society and are what motivated my establishment of this blog when I was out of academia. I always found that practicing pharmacists appreciated these kinds of timely alerts complete with the basic science underlying these developments. My only suggestion to my pharmacy colleagues is that they might care to embed hyperlinks in their reference list. I'm not being entirely self-serving (although I appreciate the readership). If you're going to go through the trouble to reference blogposts and other peer-reviewed references complete with the URLs, just embed the URLs for easy clicking. In fact, one of the URLs in the reference list has a spacing issue that improperly directs the readers when copying-and-pasting. Nevertheless, thank you for directing Texas pharmacists to our humble little blog! Thanks to TIME Healthland writer and author, Maia Szalavitz While we're on this topic, I also need to thank science journalist, Maia Szalavitz, for citing our work yesterday in the widely-read TIME Healthland blog where she is a regular contributor. "Outlawing 'Legal Highs:' Can Emergency Bans Hinder Drug Development?" addresses the often-overlooked consequences of broadly assigning compounds to Schedule I of the US Controlled Substances Act: Compounds that may not have been adequately studied for therapeutic benefit might never be fully investigated if relegated to this most-restricted status. By definition, Schedule I compounds have no known medical benefit. However, if they are not studied for medical benefit, none will be found. In support of this notion, Szalvitz cited a 2005 Journal of Neuroscience paper from a Spanish neurodegeneration research group led by Dr. Maria de Ceballos at Madrid's Cajal Institute. Following from work showing that senile plaques from Alzheimer's disease patients express cannabinoid CB1 and CB2 receptors, the investigators showed that synthetic cannabinoids can prevent β-amyloid peptide-induced activation of microglial cells, known to produce inflammatory mediators that are neurotoxic. Preventing an major neurodegenerative disease with psychoactive compounds might not necessarily lead to a major therapeutic advance. However, the basic pathophysiology of Alzheimer's disease and other neurological disorders can certainly be advanced by access to these research tools. DEA...

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