Superhero Syndrome

Earlier this month, American Psychiatric Association (APA) released the organizational framework proposed for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to be published in 2013. APA is restructuring the DSM’s chapters and categories of disorders to signal the latest scientific thinking about how various conditions relate to each other and may influence care.

APA is again inviting comment from the general public, mental health providers, and other healthcare professionals who use the manual for both diagnostic and research purposes. As part of the development process, the preliminary draft revisions to the current diagnostic criteria for psychiatric diagnoses are now available for public review.

And since APA is inviting comment, I thought that I'd suggest inclusion of a new syndrome that I've noticed occurring more frequently with some of my retail colleagues over the past few years.

- Superhero Syndrome.

While this syndrome can occur in any overly-busy pharmacy environment, it most often seems to strike pharmacists working in retail pharmacy. Why is that?

Because as employers have been increasing demands for production, reducing support staff, adding additional patient care responsibilities, all while also requiring dispensing speed and accuracy, many pharmacists who are able to survive in such an environment for an extended period of time have come to consider themselves Superheroes.

And rightly so. Just like all doctors consider themselves superheroes, pharmacists should consider themselves superheroes too. But even superheroes have their breaking point.

Now add to all of those responsibilities, the additional responsibilities and the liabilities of having to police the narcotic and pseudoephedrine abusers while constantly worrying about being shot by the criminals, being prosecuted by law enforcement, or being hung out to dry by their employers, it's no wonder that many retail pharmacists are now experiencing something called - Superhero Syndrome.

The stress of Superhero Syndrome seems to be taking such a toll on pharmacists that even scotch doesn't faze it. As the image above shows, not even Prozac is an effective treatment for it. I think it's become a seriously unhealthy mental disorder, and something needs to be done to address it.

Unfortunately, many superhero pharmacists refuse to use their own powers to help themselves. They continue to let the Jokers and the Two-Faces beat them down. They haven't yet realized that the evil forces in the insurance industry and corporate world view them, not as superheroes or powerful allies, but as expensive and expendable liabilities.

So, I'm asking APA to step in and consider adding this often misdiagnosed syndrome to the DSM-5. The superhero pharmacists need you. If the psychiatric profession can convince these pharmacists to let go of their fears and use their collective individual powers to fight back, then there's a slight chance to eradicate Superhero Syndrome before it takes its toll on the entire profession.

Image Source: Comics Alliance

A Drug By Any Other Name

While I write this blog for myself and other pharmacists, I realize that many non-pharmacists read it too. So, I like to include posts to help the public understand why things happen behind the counter, to help them understand how medication errors may happen, or how to help prevent medication errors themselves.

One of the questions that I've heard from upset patients before is, "how the hell did the pharmacist mix up two drugs that are completely different, and don't even sound the same"? As I've described previously, piss-poor handwriting can easily lead to dispensing errors.

From Susan Proulx, PharmD at Med-ERRS, here's how easily it can happen -


Lipitor or Zyrtec? How a doctor's bad handwriting can change your prescription from Marketplace on Vimeo.

Justice Not Served

Personally, I believe that if you attempt to rob a pharmacy at gunpoint, you forfeit all of your rights of protection, and you should be held solely responsible for the consequences resulting from your actions. In my opinion, justice was not served today.

A solemn jury found Oklahoma City pharmacist Jerome Jay Ersland guilty of first-degree murder today in the fatal shooting of a robber two years ago.


Source: NewsOK: OKC Pharmacy Shooting

Outsourcing In The Pharma Industry

It's seems as though a new strategy has emerged in the pharmaceutical industry to now outsource it's clinical trials work. According to a recent article posted on FierceBiotech, Pfizer is seeking to reduce it's clinical trials overhead by more than 9 billion dollars.

As Pfizer lays off thousands of R&D workers and scales back a research wing which consumed a whopping $9.4 billion last year, it's turning more to outside companies to handle trials rather than keep everything in house. Pfizer is following a path already blazed by rivals like Sanofi, which has developed a close relationship with Covance. And the change has helped drive a wave of consolidation in the CRO world as companies band together into large global operations that promise to provide a more efficient method for development as they compete for these exclusive deals.

But, as any cynical pharmacist might wonder, just how far will this outsourcing go in order to provide a more efficient method for generating pharma profits?

Image Artist: Penbender at Worth1000.com

How To Handle A Difficult Customer

Sometimes.. okay almost daily, you'll probably run into a customer looking to pick a fight with you. Most of the time they seem to catch you off guard and when you least expect it, so one tends to get defensive when confronted.

But, like this pharmacist caught on the store's security "safety" camera, it's best to step back, calm down, regroup yourself, and do the unexpected. It works for me most of the time.

[Your may have to turn the volume way up to hear the conversation]


Chill Pill - Pharmacy Scene Select from Lauren McKeithan on Vimeo.

Florida Pharmacists Under Fire

Once again, due to the actions of a few, the responsible pharmacists have to suffer.

The State of Florida, which many consider the epicenter of prescription drug abuse, has recently taken drastic measures to curb being known as the "pill mill" state.

Unfortunately, those measures include costly and punitive legislation for Florida pharmacists. According to a summary of Florida House Bill 7095 which takes effect on July 11th -

Community pharmacies must be re-licensed under the provisions of this act and rules adopted thereunder by July 1, 2012. Additional licensure requirements are intended to prevent felons and other nefarious persons from owning or operating pharmacies. In addition, pharmacies will be required to develop policies and procedures to minimize dispensing based on fraudulent representations or invalid practitioner-patient relationships.

A pharmacist must report to a local law enforcement officer any person who obtains or attempts to obtain a controlled substance through fraudulent methods or representations. The failure to report is a misdemeanor of the first degree. (my bold)

Principals associated with a pharmacy must undergo annual criminal background screening. The department must forward the results to wholesale distributors permitted under ch. 499, F.S., for purposes of complying with the requirements related to due diligence of purchasers.

The amendment includes additional requirements and disciplinary action related to activities in pharmacies and by pharmacists.

But, this is just a summary of the new laws. The finer details are still be worked out and could negatively-impact innocent and responsible pharmacists even further. According to an article in PNJ.com, one independent pharmacist is concerned about the ability of the profession to remain self-regulating.

And rightly so too. Who's to decide whether or not a pharmacist knew if a prescription was fraudulent? Would you rather have a board of your peers decide that, or someone else not familiar with how a pharmacy operates?

Not to mention that you could also be held criminally liable for your mistake. A first-degree misdemeanor in the State of Florida is a crime punishable by no more than one year in jail, one-year probation, and a $1,000 fine.

Advice To New Graduates

I stopped by and read The Angry Pharmacist's recent advice to new grads, and I couldn't agree with him more. If you haven't realized it yet it in the four years that you've been in school with your future "colleagues", it's not the customers or patients that you need to watch out for, it's your co-workers and apathetic supervisors. They're the ones who are going to make your career miserable.

Take it from someone who's experienced being screwed by those who seemed the most trusted. Don't think everyone is your friend or looking out in your best interests, they're not. When push comes to shove, your colleagues will throw you under the bus.

The best advice for you is to don't try to keep up with the Joneses, live below your means, save your money, and carry no debt. Freedom from debt gives you the power of choice. Because, this is what you have to look forward to in the workplace -





I see what you mean Cynical Pharmacist, but why in the world would a professional colleague want to treat one of their own so poorly? I mean, what possible reason could another pharmacist have to put their own interests ahead of mine, and even the profession as a whole?

Well, let me introduce you to the real world with a little 1970s-style answer.

Old School Medicine

Back when I was a kid there was no such thing as ADHD.

I've always been suspicious that the ever increasing levels of ADHD diagnoses were created to create more psychiatric positions, generate pharmaceutical company profits, or to justify poor parenting skills. It's easy to blame a disease or disorder.

In many of these cases a child's behavior can be attributed to just "kids being kids". It's normal for kids have short attention spans and lots of energy. Think back to your own childhood. If any of us got out of line or didn't pay attention, it wasn't because we had a psychiatric disorder, we were just impulsively acting our age.

If our behaviors got out of line, no big deal. Our parents and teachers prescribed their own treatments for hyperactivity. These treatments seemed to work, and they didn't require a trip to the doctor and prescription for pills. We turned out okay, right?

Maybe we need to reassess some of that old school medicine. What do you think?


Meet Doctor Shay from Kranky Kritik on Vimeo.

Urology Name Fail

I'm not sure how this urologist stays in practice. It doesn't seem to me like he would have any repeat business. Maybe his other team members, Dr. Hardeman and Dr. Wang, send him their overflow patients. Via FailBlog.org.

According to The Urology Team website:

Dr. Richard (Dick) Chopp is well known in the Austin community for performing Vasectomies. He also enjoys treating patients with metabolic evolution of kidney stone disease, male endocrine urology disorders, prostate disease and Peyronie's disease.

Now, I don't know about you, but I'd be a little hesitant before I let anyone named Dick Chopp perform a vasectomy on me.

Time For An Attitude Adjustment

Life is hard, and sometimes it'll beat you down if you let it.

But, it's not always a pill that'll cure your ill.

Many times the best medicine is no medicine at all. With a little help from someone who cares about you, often all it takes is a little psychology and the right kind of motivation.


Dr Knowgood: Lion's Pride from Arnold Zwanenburg on Vimeo.

The Stiller Gambit

I'm sure you've all heard the news that the head of the International Monetary Fund (IMF) and possible future candidate for the presidency of France, Dominique Strauss-Kahn, has been arrested on sexual assault charges.

Strauss-Kahn is accused of attacking a maid who had gone in to clean his penthouse suite Saturday afternoon at a luxury hotel near Times Square. He is charged with attempted rape, sex abuse, a criminal sex act, unlawful imprisonment and forcible touching.

Mr. Strauss-Kahn has pleaded "not guilty" and denies all of the charges. So, as most men of means will do, he's hired a top lawyer whose previous clients included defendants with colorful nicknames such as Vincent "The Chin" Gigante and Sammy "The Bull" Gravano, to defend him against the charges.

Believe me, this lawyer is no slouch, and probably worth every penny he's being paid. Word in the street has it that he's already put together a Teflon defense that's sure to convince any potential juror of his client's innocence.

Rumor further has is that he's calling his defense of Strauss-Kahn, "The Stiller Gambit". The strategy behind the Stiller Gambit is to deflect blame for this alleged criminal behavior from Strauss-Kahn himself, and onto the pharmaceutical industry. It seems pretty clever to me.

Here's the reasoning behind the gambit and why it's allegedly supposed to succeed -


Remember - Ei incumbit probatio qui dicit, non qui negat.

Foolish Choices

In all aspects of life, whether it's personal or professional, if you allow others the choice to take control of your life, they will. That's how most people roll.

If you freely give others power over you, the chances are that they'll abuse that power, no matter how much it harms you. Their own interests will always become paramount.

So, don't whine about the consequences of your impulsive and foolish choices afterwards. You'd be much better off thinking about those choices long and hard before you make them.

Your life may depend on it.


Source: 5-Second Films

Everyone Loves A Slinky

But no one loves a slinky better than this pharmacist slugger from Louisville.


Source: Kristoffer Borgli

Pharmacy Robbery On Tape

Have you experienced the terror of being one of those unlucky pharmacists who has been a victim of an armed robbery? If you work in a community pharmacy, chances are that it's going to happen to you sooner or later.

To show just how quickly these things happen, I found this removed video story example out of the State Florida. It's all very clear just how easy it is to rob a pharmacy, and just how scary it is for pharmacy workers. It was all over within a period of two minutes.

[Original video link removed by source]

The American Dream

Yesterday would have marked George Carlin's seventy-fourth birthday.

For anyone who doesn't already know, George was known for his mixture of observational humor with larger social commentary, one of my goals with this blog. I've always admired George's honest and cynical comedic talent, mostly because his views on humanity were right on the mark, and because they closely mirrored my own.

Here's to you George for pointing out the bullshit and telling it like it is.

Prescriptions Ready

Prescriptions ready for Topliss and Willing.

Source: Epic Win!

Dietary Supplement Or Antibiotic?

I'll always be able find worthy topics to post on The Cynical Pharmacist because if there's one thing that I'm sure about, it's that there will always be criminals looking to exploit innocent people in order to selfishly line their own pockets.

What do you see when you look at this picture?

I'm a pharmacist living close to the Mexican border and am familiar with a lot of Mexican drugs, and I would have thought that the two dietary products in the background were Amoxicillin at first glance. So does the FDA and the Texas Attorney General, who say these products amount to nothing more than deceptive advertising and unlawful marketing.

According to Texas Attorney General, Greg Abbott whom filed suit -

According to state investigators, the defendants’ Amoxilina labels claim – in Spanish and English – that the dietary supplement is “without side effects and Naturally Combats Infection.” Multimex also prints a Spanish phrase on the back of the capsule membrane that states “(Cualidades Antibioticas Naturales)” – which means “Quality Natural Antibiotics.” Consumer complaints received by the Attorney General’s Office indicate that Spanish speaking parents purchased the supplement for children suffering from throat or ear infections because they believed that they were buying Amoxicillin.

The antibiotic, Amoxicilina, was once available in Mexico without a prescription. But it's not just the similarity between names alone. The deceitful marketing of Amoxilina, the lawsuit charges, included a two-toned, blue and white box that mimics the packaging of Amoxicillin - right down to the red letters used to display the product's 500mg strength.

The FDA initiated a recall after four children were taken to a Medical Center due to worsening illnesses after giving the dietary supplement delayed legitimate medical treatment.

Of course, it's being reported that Multimex owner Sandra Salazar says her company didn't intend to mislead customers. What do you think?

Retail stores and distributors should return the products to Multi-Mex, 4744-C North Royal Atlanta Drive, Tucker, Georgia, 30084. Consumers with questions may call at (678) 226-1758 (Monday-Friday 9:00 am – 5:00 pm EST).

The Pharmacist

Spencer's a narcoleptic. Ten years ago he fell asleep and something very, very bad happened and he's been afraid to live ever since.

But his safe, repetitive life has evolved into a rut that's beginning to feel an awful lot like a grave. And so Spencer decides to die. That's when a dear friend reminds him that, if he's going to die soon anyway, he might as well go crazy first.

An independent Canadian film, The Pharmacist is about a man who can't find anything to live for until he finds someone to die for.


THE PHARMACIST/LE PHARMACIEN trailer from Domino Film on Vimeo.

You Go Girl!

Did you ever notice that it's usually the male pharmacists whom complain about having to work 12-hour shifts behind the pharmacy counter without being given a bathroom break?

I always wondered why it seemed that female pharmacists were more stoic than their male counterparts in this area, so I thought this unusual quality warranted further investigation.

Well, lo and behold, look what I found out. Now I know why they save all of those empty Tussionex bottles. Here's a few of them sharing their secrets. You go girls!

Refills Are Not Forever

Folks, I know you've been told that you have to take your medication forever, but your prescription refills don't last forever. Don't blame me because you forgot to make an appointment with your doctor.

Source: Mental Health Humor

Pour Me A Stiff One

There was a time when you'd ask your bartender to "pour me a stiff one" and the bartender would oblige you with a shot of whiskey.

Times have changed my friends.

Concerned about the family jewels, Scottish brewing company, Brew Dog, has announced a new beer made specifically for the Royal wedding.

It's called "Royal Virility Performance," and it's an India Pale Ale marketed as containing herbal Viagra, chocolate, goat weed and a "healthy dose of sarcasm."

Now, I know what you're thinking.

But, as any cynical pharmacist would tell you, Royal Virility Performance probably isn't laced with "actual" Viagra (sildenafil) because, like in the United States, sildenafil is a prescription product requiring a visit to your doctor first (or available from some pharmacists in the UK).

However, it may contain other OTC purported aphrodisiacs like Horny Goat Weed, chocolate, and even perhaps, an "analog" of sildenafil which hasn't been tested and approved for safety and efficacy by the people looking out for your health and welfare.

If so, that would put Royal Virility Performance in the same category as other unapproved liquid aphrodisiacs, like Magic Coffee, which could possibly cause serious harm, or even death. So, what I tell my patients is "why take the chance of something going wrong when a product is only "marketed" as, and not "proven" to be, an aphrodisiac?"

Be safe and don't buy into all of the bullshit. If you really need something OTC to put a little spice in your life, try something that has been "marketed" as an aphrodisiac, but has also been "proven" NOT to be harmful when taken as directed?

It's easy to find and not that expensive to buy. Stop by your local pharmacy and ask your pharmacist to point it out to you in the vitamin section.

It's Not OK In Oklahoma

As a matter of fact, pharmacies (and pharmacists) aren't safe anywhere in America.

[Original video link removed by source]

Speak Up To Prevent Errors

I think I speak for all healthcare providers when I say, "help us help you".

We are not infallible. I've never met any healthcare professional who would intentionally try to harm one of their patients, it's devastating on both ends. But as much as we try to prevent them, mistakes can happen. You can help us prevent them.

Please become an active participant your own health care and learn to question everything that's being done to help you. When your doctor or other healthcare provider gives you a prescription, politely hand it back and ask that provider to read it to you.

This one simple step will allow that provider to double-check what was written, and will keep you from having decipher and understand his or her form of ancient Sanskrit handwriting.

This will also help prevent errors or delay at the pharmacy, as you can quickly tell the pharmacist what the doctor prescribed in case the pharmacist can't read it either.

This same simple step should also be applied when picking up your prescription at the pharmacy. If the pharmacist hasn't already done so, politely hand the bottle back to the pharmacist, and ask him/her to "Show and Tell". They know what that means.

The pharmacist should open the bottle, show you the medication, and read the whole prescription label to you. Doing so will allow the pharmacist another chance to catch any errors. It should also match what the doctor told you. If not - Speak Up!

Is This Why My Copay Is So Cheap?

I stopped over at Dr. Grumpy's House to see how he was doing today. Needless to say, I couldn't get out of there quick enough. Think I'll stop by again after he's had some lunch.


Source: Project Rant

Justice From The Front Lines

From the Department of Justice: CVS Pharmacy Inc. Agrees to Pay $17.5 Million to Resolve False Prescription Billing Case.

According to an excerpt from this Justice Department news release -

The settlement resolves allegations that CVS submitted inflated prescription claims to the government by billing the Medicaid programs in Alabama, California, Florida, Indiana, Massachusetts, Michigan, Minnesota, New Hampshire, Nevada and Rhode Island for more than what CVS was owed for prescription drugs dispensed to Medicaid beneficiaries who were also eligible for benefits under a primary third party insurance plan (excluding Medicare as the primary payor). The United States alleged that rather than billing the government for what the insured would have been obligated to pay had the claims been submitted solely to the third party insurer (typically the co-pay), CVS billed and was paid a higher amount by Medicaid.

So, who turned in CVS to the Feds? Smart front line pharmacist Stephani Leflore, of St. Paul, Minn., who started as an overnight CVS pharmacist in 2008.

I wonder if she is like many other chain pharmacists who've gotten fed up with the prescription redlining and time guarantees, the overburdening workload and constant rush to fill prescriptions quickly, the increasing requirement of having to answer to non-pharmacists, the rapidly diminishing power over their professional destiny.. and having to pay for Medicaid fraud out of their own taxes?

Now, it's not like Stephani didn't try to do the right thing and alert her supervisors of the alleged over-billing beforehand. According to Claudine Homolash, a partner with Sheller, P.C. who specializes in whistleblower, pharmaceutical, and consumer protection litigation -

Ms. LeFlore claimed in her federal and state lawsuits that CVS should only have billed the Medicaid program the same limited co-pay on prescriptions that it would have normally billed the customer under the insurance plan. She alleged that CVS designed a billing software program for its pharmacies that consistently overcharged Medicaid on these co-pays. She claimed that these overcharges occurred on hundreds of thousands of prescription sales for well over five years.

Ms. LeFlore first complained internally, but she was told by a supervisor that “corporate took care of the billing” and that she need not be concerned.

So, if you ask me, what else could a conscientious, responsible, and ethical pharmacist do but to empower herself and turn whistleblower? Wouldn't you do the same?

Pharmacy Truth In Advertising

The one thing about this profession that I can't stand is all of the phony bullshit and political correctness. How many times have you read a pharmacy job opening that actually told you the truth and what's to be expected? Never, right?

So, when I read this recent pharmacy technician job listing on Craigslist, I couldn't help but crack up. How truthful is this?

We need a Pharmacy technician for 20 hours a week. The office will be moving to Recker and Ray in May, but for now the Pharmacy is at Alma School and Guadalupe. To do this job, you must LISTEN, the last technician just wanted to complain about everything and never let anyone else talk. This job is flexible, and requires scrubs. Bags or Purses will not be allowed in the pharmacy. You will start out as a contractor and then your hours will steadily increase as time goes by. The last technician had a lot of DRAMA, keep your drama at home. I don't want to hear about your Ex, your children or your car, its your job to be here on time at the times that we set up and you are there to work, not talk to your boyfriend/girlfriend, not text your friends, not bid on something on EBAY or shop on Amazon. If you want a job and will work, then apply, if you want a job where you can be social and goof off, look elsewhere.

Whoever wrote this ad, thank you very much for telling it like it is and partially restoring my faith that a few pharmacists actually have the balls to speak their minds.