On Drugs

Today I received multiple emails urging me to voice my opposition to the “21st Century Cures bill.” Specifically opposed by Elizabeth Warren, it was passed by the House yesterday and is now headed for the Senate. Here’s one of the more level headed things written about it today.

So, here’s something that might concern you. This bill would specifically allow something called “off-label use” of drugs. More specifically, it allows drug manufacturers to mention these off label uses, rather than leave it to word of mouth among doctors. Critics call that “Fraud”, adding “If this bill passes, Big Pharma could market drugs as cures for all sorts of symptoms, not for the uses that were approved by the FDA. That sort of fraud puts people at risk.”

That’s simply not how it works.

Let me start with a common example that you or somebody you know might be familiar with. There’s a drug called Gabapentin, name brand Neurontin. It’s approved as an anti-seizure medication. The truth is, there are many better drugs for seizures, but Gabapentin is really good at controlling nerve pain (“neuropathy”). Many diabetics use this drug to control diabetic neuropathy (it’s cheaper than that stuff you see advertised on the TV, and has a longer track record for safety simply because it’s been around for years). So this bill would say that the makers of Gabapentin could run an ad saying doctors use this stuff all the time for neuropathy.

People like Elizabeth Warren who are calling this “fraud” think somebody should pay for a bunch of new research studies to prove what doctors and patients have known for years: this stuff works pretty well for something other than it’s original purpose.

The fact is that one out of five prescriptions written today is for an off label use — what critics are now calling “fraud” — and there are perfectly valid reasons for your doctor to write that prescription. In fact, if I can only get you to read one thing about this issue, let it be this peer reviewed article on the practice. Notice there’s an entire table of common off label uses, some of which are common sense (gee, morphine can treat severe pain in children, gotta do some studies on that one).

Of course heaven forbid we should address the fact that the United States is one of only two countries that allow drug manufacturers to market their products directly to consumers who — let me point this out — cannot purchase them without a prescription. Not complaining, it helps  my clients remember what some of those new meds do.

In Closing: bras; Greenwald pointing out reality again; 5 pre-screened articles by conservatives; a Home Depot employee in Alabama has virtual control of the underground economy in Venezuelaplease stick a fork in identity liberalism (it’s dead); and it’s been a long time since I’ve linked to anything in HuffPo, but it is still the economy, stupid.

Things I’ve Learned: 90 Days of Nursing

Nurse w lampHard to believe I’ve been gainfully employed as a Registered Nurse for 90 days! Here are a few things I have learned:

Kinda cool: It’s a little thrilling to do some of those things that nursing students aren’t allowed to do for the first time: dispense certain medications, countersign high-risk meds, sign a nursing note with RN at the end of your name.

Happy Feet: Those shoes that got you through 8 hour shifts in nursing school may well be very inadequate for 12 hour shifts in real life. Keep in mind that a nurse very likely puts on 10,000 steps a day, minimum. She (ok, sometimes he) also spends a lot of time standing. Get good shoes. Also, consider upgrading your socks.

Time Keeps On Slippin’: Good time management skills are absolutely critical to doing all the things you need to do over the course of your shift.

The Little Things: There are a lot of nursing skills that require some serious fine motor skills. A nurse learns to do a lot of things one handed, with the other hand on the patient in some way. Oh, and some medications are just ridiculously hard to get out of their individually wrapped containers while wearing exam gloves.

A Spoonful of Sugar: A little old fashioned Dale Carnegie interaction with patients (and even coworkers) goes a long way at work.

On Uniforms: I kind of like wearing a uniform to work. I like being able to look around my facility and know exactly who does what.

That’s My Line!: Many people don’t understand the difference between a nurse and a CNA.

Reality Break

Dear Democrats on the Internet:

Have you lost your everlovin mind?

We just finished an election where the American voters rejected not just one, but two political dynasties. Furthermore, just about everybody except Maddie Albright rejected the notion of “vote for the girl ’cause she’s a girl.” And finally, voters rejected the notion of a “everything is fine nothing is broken” politics-as-usual candidate.

Michelle Obama would be a terrible choice for Democratic nominee in 2020. Not because she’s a woman. Not because she’s black. Not even because certain Republicans have spent the last 8 years criticizing literally everything about her.

Because we don’t pass down the Presidency like it’s some kind of crown.

And furthermore, she’s not interested.

The Hangover 2016

Happier times?
Happier times?

Ok. Everybody recovered from either celebrating or being sad and confused yesterday? Good. Let’s take a collective deep breath or three. It’s time to talk like grown-ups about what happened this election.

Protest signs with swear words are not helpful. Stop it with the popular vote argument unless you were equally outraged in 2000.

I’d like to share some of the more level headed things that were said yesterday about Hillary’s defeat. No, not Trump’s win, but Hillary’s defeat. There were a lot of people who had a  hard time choosing between — as this season of South Park put it — the douche or the turd sandwich. No, you can’t boil this down to “hate won” or “xenophobia and misogyny.” So here I offer the thoughts of Ryan Bort and Juan Cole. Note the theme of an enraged electorate whose standard of living has been in decline.

Hillary was a weak candidate: a “limousine liberal” in a time when Joe Average is not doing well. She was beset by scandals both real and imaginary.

Her slogan was “Stronger Together,” but she ran on “Come now, be reasonable and accept small variations on the status quo.” Bernie Sanders’s ideas? Come now, be reasonable. Recent radio ads purportedly sharing the thoughts of Republicans planning to vote for Clinton actually used the words “She’s reasonable.

Here’s a good summary: “She was a weak candidate with tremendous baggage and very high unfavorable ratings. She was a status quo candidate with a status quo campaign in a change election.” And yet the decision was made very high up in the DNC that it was “her turn.”

So yeah, it’s time for a shakeup in the Democratic Party.