New policy, Marie

This year the Girl Scouts are requiring background checks on people looking to buy cookies, to prevent unfortunate incidents of this type from happening.

Dear Uloric,

Thank you for inviting me to watch "leading physicians" discuss your product.

Honestly, however, all I see in this picture are 2 gents who appear to be desperately in need of a men's room.





In fact, they look sort of like I do on weekend call (though better dressed), loaded with Diet Coke, having no time to pee, smiling blandly as the ER pages me again, and wondering how much it would hurt to put a catheter in until Monday morning to save time.

Help wanted: New medical secretary

Dr. Grumpy: "Hey, where are the Peanut Butter M&M's?"

Mary: "Oh, we put all the M&M's in the tupperware container over there."

Dr. Grumpy: "But there were 2 bags, the PB's and the dark chocolate..."

Mary: "Yeah, we just put them all in it. It's over there."

Dr. Grumpy: "You mixed PB's with dark chocolate? That's sacrilege!"

Mary: "You're a doctor. The PB's are bigger. I'm sure you can tell the difference and pick them out."

Dr. Grumpy: "That's not the point! You shouldn't mix them! The crappy dark chocolate ones will contaminate the PB's just by being in contact with them."

Mary: "Tough. From looking at your butt I don't think you need either."

Yes, those count

Dr. Grumpy: "Any major illnesses in your family?

Mr. Needle: "Nope. Everybody is healthy. I mean, unless you count diabetes. Or cancer. Or heart stuff."

I guess it's a pop-up ad, huh?

I'm reading the news online this morning, and this ad was on the web page.

I can't help it. I'm immature and juvenile.

Sunday afternoon, 1:28 p.m.

Mrs. Grumpy and I are taking a nap. My home phone rings, waking me up.

Dr. Grumpy: "Hello?."

Mr. Pissmeoff: "Hi, um, Dr. Grumpy. You don't know me, but my kids also go to Wingnut Elementary, and I got your phone number out of the school directory."

Dr. Grumpy: "Uh-huh..."

Mr. Pissmeoff: "My wife has MS, and is in Local Hospital. She sees Dr. Darth, across the street from you."

Dr. Grumpy: "I don't cover for Dr. Darth, sir. You'll have to call his office."

Mr. Pissmeoff: "I know you don't. But she wants to go home, and he hasn't been in to see her yet today. Can you please come in and discharge her instead?"

Fire safety

I was on my way to Costco yesterday.

I passed an old Ford pickup. It had been modified so the ENTIRE BACK OF THE TRUCK was gone. They'd shortened the axle, and had the rear wheels under the cab.

They had the gas tank welded to the roof of the cab, with fuel lines running down over the windshield to the engine. There was no hood.

The windows were open. The driver was smoking.

More crap

All right, ever since I became side-tracked on what I consider to be the major threat currently facing humanity - the sickening overuse of the word "artisan" and its derivatives - everyone else has been noticing it too. Recently it's even been prominently featured in a nationwide TV ad to describe mass-produced ravioli, of all freakin' things.

Anyway, since it's too late for me to go back and pretend I never started this, here are some of the more irritating examples of the problem that have been sent in:


From Shannon, who says this was at Starbucks (assumedly not made by kosher artisans). This one gets bonus irritation points for also having the word "handcrafted" in it:






Kathy saw this at the grocery store:






And Jaime, also from the grocer's:

Patients say the darndest things

Dr. Grumpy: "Any side effects on the medication?"

Mr. Stiffy: "Well, I uh, I mean, um... you know, I, uh, when I'm about to, um, fall off the cliff, so I start rubbing it faster, but I don't fall off that cliff, no matter how fast and hard I rub. You know what I mean, doc?"

Ma'am, that isn't normal

Get 15% off hospital scrubs with code "white_onsale"

Mrs. Stick: "My blood sugars are always good. I check them 4 times every day."

Dr. Grumpy: "I didn't know you were a diabetic?"

Mrs. Stick: "I'm not, but my husband is. I use his lancets."

Dr. Grumpy: "Why on Earth do you do that?"

Mrs. Stick: "Just for fun."

Drug 'R Us

Pharmaceuticals are amazing stuff. You can bitch and moan about their costs, side effects, or the number of them you're taking, but what they've done to extend life and improve its quality is truly remarkable.

And for all the bad raps they get, I salute the pharmaceutical industry, and those who work anonymously in labs around the world, to bring us these miracles.

But drug companies also do absolutely weird crap. One thing that's recently driven me nuts is the trend away from drugs of real value toward what I call "drugs of convenience" (DoC).

What is a DoC? Let's take Fukitol. Fukitol is dosed twice-a-day. Taking a pill twice-a-day is something most of us can remember to do. Fukitol costs, say, $2 a pill. So a month of Fukitol is $120 (these numbers are just for example, obviously).

But, like all drugs, Fukitol's patent is going to expire. Then it will become a cheap generic (fukazolamide), and the price will drop to $0.20 per pill. So a month will now cost $12.

About 3 months before the generic comes out, the Fukitol rep shows up at my door. He now carries once-daily Fukitol-ER! Yes, now you only need to take Fukitol-ER once-a-day! And they trumpet this like it's a major freakin' medical breakthrough.

And they no longer carry plain old Fukitol samples. So if I want to start someone on Fukitol, I need to use Fukitol-ER, and when it goes generic in a few months, the patient ain't gonna want twice-daily fukazolamide.

Fukitol-ER is priced at $4 a pill, so a month is, again, $120.

When the generic comes out, the patient's insurance has a choice: pay $12/month for twice-daily fukazolamide, or $120/month for Fukitol-ER. That $108 difference becomes pretty significant if there are, say, 1 million people on the drug.

Now we get into numbers. The patient's insurance co-pay is $5/month for fukazolamide OR $40/month for Fukitol-ER. The insurance company is hoping that by putting more financial burden on Mr. Fukdeprived, he'll decide to go with the cheap generic.

But the drug companies have a counter to this- They've introduced coupons, also called "co-pay cards" or "patient loyalty cards" that give the patient $40 a month off the copay. So by using these things Mr. Fukdeprived gets Fukitol-ER free, while the insurance company is still getting dinged for the rest of the cost.

Now, given my never-ending battles with insurance companies, I don't often sympathize with them. But here I do: the patient is getting the gold mine, and the insurance is getting the shaft. And, of course, this situation increases health care costs for ALL of us, because the insurance has to raise my premiums to pay for the fact that somebody just can't bear the thought of having to take their pill twice-a-day instead of once.

My friends who are pharmacists also hate having to deal with the reimbursement issues on the co-pay cards, but that's another story. If they want to comment on it, they're welcome to.

But the fun doesn't end there. Let's take a real drug: Flexeril (generic name cyclobenzaprine). This muscle relaxant came to market quite a while back, and consequently has been available as a generic for many years. It's taken as a 10mg pill 3 times a day, and the generic is dirt cheap. Like a few pennies per pill.

So roughly 10 years ago, LONG after generic 10mg cyclobenzaprine was commonly available, some enterprising drug company actually was able to patent it AGAIN as a 5mg pill. They claimed it was less sedating at the lower dose, and therefore constituted a whole new drug.

And so it went to market as expensive Flexeril 5mg, because heaven forbid you should actually suggest a patient buy cheap generic 10mg cyclobenzaprine and break them in half!

Eventually the patent wore off on Flexeril 5mg, too, and it went generic, along with the 10mg. So what happened next? Another drug company actually re-patented it at a 7.5mg dose and renamed it Fexmid. I am not making this up.

Still another company has developed a once daily form of it called Amrix. So from 1 drug we now have 4 freakin' patents.

Here's another one: Doxepin is an ancient (by drug standards) antidepressant. It's been around since the 1960's. So it's dirt cheap, and comes in pills of 10mg and up. BUT some pharmaceutical company, after 40 years on the market, has re-patented it as a 3mg or 6mg sleep aid called Silenor. So you can buy 30 days worth of 10mg pills at Target for $4 OR you can pay the same amount per pill for Silenor in a smaller size. Step right up and buy this bridge!

But the fun goes on! One that REALLY chaps me is the bizarre trend of combining 2 old, cheap generics (some of which are even available over-the counter) to create a new, overpriced drug.

Other companies combine an existing generic with a soon-to-be generic as a desperate way of getting a few last bucks out of it. Because heaven knows it's SUCH a serious burden to have to take 2 pills at the same time instead of 1. This list includes Treximet (Imitrex + Naprosyn), Vimovo (Naprosyn + Nexium), Caduet (Norvasc + Lipitor), Vytorin (Zocor + Zetia), Symbyax (Prozax + Zyprexa), and many more.

No matter how much pharmaceutical companies try to portray these drugs as major medical breakthroughs, THEY AREN'T!

I just can't help but think that the money spent on creating them would be better spent on more novel drugs with greater long-term potential (and profit, since I admit that's the key) to help people.

Dog owner tip

Okay, marijuana fans, lets remember this:

Dogs have different uses for socks than you do.

So, if you are hiding your stash in a sock, your dog may have a different idea of what to do with it.

Like this guy's did.

Annie's desk, February 15, 2011

Annie: "Dr. Grumpy's office, this is Annie."

Mr. Alpo: "Yeah, Dr. Grumpy sees my wife for Parkinson's disease."

Annie: "Uh-huh..."

Mr. Alpo: "I need a refill on her medication, and also, does Dr. Grumpy have a dog?"

Annie: "Yeah... Why?"

Mr. Alpo: "Can you ask him what kind of dog food he recommends?"

Annie: "Let's stick with the medication refill. Dog food isn't his field."

Mr. Alpo: "Yeah, but he's a doctor. Doesn't he know about that stuff?"

Annie: "He's not that kind of doctor. Why don't you ask your vet?"

Mr. Alpo: "Why? Does she know Dr. Grumpy?"

I'm SO freakin' touched

Today a drug rep dropped off this box of chocolates at the office.