Online pharmacy weblog

You can’t see it, smell it or taste it. But food or water tainted with
E. coli O157:H7 can leave you fighting for your life, especially if
your immune system is compromised or you’re very young or very old.

Seven people died and more than 2,300 others fell ill in Walkerton,
Ont., in May 2000, in Canada’s worst-ever E. coli outbreak after the
bacteria got into the town’s water supply. The source of the
contamination was manure spread on a farmer’s field near one of the
town’s wells.

While the Walkerton case was unusual, health authorities across the
country normally deal with a few thousand cases of E. coli illness a
year. In the U.S., it’s estimated that 73,000 people are sickened by
the bacteria every year and 61 people die.

While the vast majority of people fully recover from a bout of E. coli
within a week to 10 days, some people will spend the rest of their
lives dealing with the after-effects of the illness.
What is E. coli and where does it come from?

E. coli, short for Escherichia coli, is a type of bacteria commonly
found in the intestines of animals and humans. There are hundreds of
strains of the bacterium, but E. coli O157:H7 has been identified as
the most dangerous to people, producing a powerful toxin that can
cause severe illness.

It was first recognized in the United States in 1982, when an outbreak
of severe, bloody diarrhea was traced to contaminated hamburgers,
leading to the illness to be dubbed as “hamburger disease.”

E. coli O157:H7 can contaminate ground beef during the butchering
process. If it is present in the intestines of the slaughtered animal,
it can get into the meat as it is ground into hamburger.
How does E. coli spread?

While E. coli is most often found in meat, it is not limited to it.
The bacteria is also found in unpasteurized milk and apple cider, ham,
turkey, chicken, roast beef, sandwich meats, raw vegetables, cheese
and contaminated water. In September 2006, an E. coli outbreak that
killed three people and made more than 200 ill was traced to spinach
grown in California. Bean and alfalfa sprouts have also been recalled
due to E. coli contamination.

Fruits and vegetables that grow close to the ground are susceptible to
E. coli contamination if, for example, improperly composted cattle
manure is used as a fertilizer.

E. coli, salmonella and cryptosporidium can also be found in
unpasteurized juice. Children, the elderly and people with compromised
immune systems are encouraged to drink pasteurized juice or boil
unpasteurized juice before consuming it.

Once someone has eaten contaminated food, the infection can be passed
person-to-person, by hand-to-mouth contact. The bacteria are most
often spread from person-to-person.
What are the symptoms of E. coli O157:H7?

Symptoms — characterized by severe abdominal cramping — can appear
within hours, but could also take up to 10 days to show up. Some
people may also be afflicted with bloody diarrhea or non-bloody
diarrhea. Frequently, no fever is present.

Some people may show no symptoms at all, but can still carry the
bacteria and pass it on to people who will become sick.
How is it treated?

In most cases, symptoms clear up on their own within five to 10 days.
The use of antibiotics is not recommended.

But in a small number of cases, E. coli contamination can lead to a
condition called hemolytic uremic syndrome (HUS). This is a
life-threatening condition that is treated in hospital intensive care
units. It kills three to five per cent of people who come down with
it. Some people who recover still have to contend with lifelong
complications that can include blindness, paralysis and kidney failure.
How does E. coli get in the water?

According to the U.S. Environmental Protection Agency, the presence of
E. coli in water is a strong indication of recent sewage or animal
waste contamination.

E. coli comes from human and animal wastes. During precipitation, E.
coli may be washed into creeks, rivers, streams, lakes, or
groundwater. When these are used as sources of drinking water — and
the water is not treated or inadequately treated — E. coli may end up
in drinking water.
What precautions can I take to minimize my risk?

Proper food handling techniques can go a long way towards preventing
exposure to E. coli. All ground meats should be cooked thoroughly so
the center is no longer pink. Other steps you can take include:

* Refrigerate or freeze meat as soon as possible after buying it
and then thaw frozen meat in the refrigerator, not on the counter.
* Place cooked meat on clean plates. Don’t re-use dishes that have
been in contact with raw meat.
* Use a digital food thermometer when cooking ground beef, which
should be cooked to an internal temperature of at least 71 C (160 F).
* Serve cooked meat immediately or keep it hot (60 C or 140 F).
* Clean and sanitize countertops and utensils after contact with
raw meat.
* Don’t store raw and cooked food together.
* If you marinate meat, don’t use the liquid as a dip or to pour
over cooked meat.
* Drink only pasteurized milk or cider.
* Drink water from a supply known to be safe. If you have a
private water supply (well) it should be tested several times a year.

Since most cases of E. coli contamination are passed from person to
person, good personal hygiene is critical to protecting yourself:

* Wash your hands thoroughly and frequently.
* Don’t handle food if you are suffering from diarrhea.
* Wash raw fruits and vegetables thoroughly before cooking or
cutting them.
* Sanitize food preparation surfaces and utensils.

Anyone known to be infected with E. coli, should not share dishes,
cutlery or glasses with anyone else. Their towels, face cloths and
bedding should be washed separately in hot water and bleach.

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THE pharmaceutical industry defends its promotional spending as a
service to science, physicians and patients. Advertising to patients
helps motivate them to improve their health, manufacturers say, and
detailing doctors keeps them abreast of new therapies and scientific
advances.

Those activities also, indisputably, boost sales. As marketing budgets
climbed toward a 2006 high of $28 billion, sales of prescription drugs
have never been higher. According to estimates published by the Kaiser
Family Foundation, the number of individual prescriptions filled in
the United States rose from 2.9 billion in 1999 to 3.7 billion in
2006; in 1994, Kaiser calculated that each American filled on average
7.9 prescriptions per year, including refills; by 2005, that number
had risen to 12.4.

For every 10% increase in direct-to-consumer advertisements within a
class of similar drugs, sales of drugs in that class (say,
antidepressants or erectile dysfunction drugs) went up 1%, Kaiser
found in a 2003 study. In 2000, direct-to-consumer advertising alone
boosted drug sales 12%, at an additional cost of $2.6 billion to
consumers and insurers.

Of more than 10,000 drugs on the U.S. pharmaceutical market, half of
all marketing budgets are used to promote 50 brand-name medications,
according to a 2003 study in the journal Clinical Therapy. And those
50 drugs are the ones that sell the best.

Prodding patients to prod their physicians, apparently, works. In
2006, a Kaiser Family Foundation survey of 834 office-based physicians
found that 28% of doctors said patients “frequently” asked for
prescription drugs by name after seeing an advertisement. Although
about half said they typically responded by suggesting lifestyle
changes, 14% of the physicians said they would, in many cases,
prescribe a different drug in the same class as the one the patient
requested. And 5% readily acknowledged that they frequently would
prescribe the drug the patient requested.

Physicians see marketing’s effects on their patients every day. But
ask the doctors whether the marketing influences their clinical
judgments or prescribing behavior, and a chill will descend upon the
room, say those who have run the experiment.

“Physicians are heavily socialized to believe that they have risen
above the normal human foibles,” said Harvard University’s David
Blumenthal, co-author of the most recent survey detailing doctor-drug
company interactions. “They clearly recognize that physicians are
human and subject to normal human influences; they just have a lot of
trouble seeing themselves as subject to that.”

Not immune to marketing

BLUMENTHAL finds it revealing that most physicians do not extend to
their colleagues the same trust. In a widely cited 2001 study
published in the American Journal of Medicine, 84% of young physicians
surveyed said they believed that drug industry promotions, including
gifts and meals, influenced the prescribing practices of fellow
physicians. Although most of these doctors acknowledged they were
besieged by back-slapping, sample-toting, gift-giving drug
representatives, 61% said they considered themselves immune to
marketing’s effects.

They are not. A 1994 study found that hospital-based doctors were more
likely to request the addition of brand-name prescription drugs to
their institution’s medicine chest after they had met with sales
representatives detailing those drugs.

Studies published in 1988 and 1992 found that physicians who attended
continuing medical education programs sponsored by drug companies, or
who accepted funding for travel and lodging to attend them, were
significantly more likely to prescribe that company’s drug than those
who did not.

Several studies have found that physicians who accept and hand out
free samples to their patients are far more likely to prescribe those
drugs than those who don’t take or have no access to samples.

Last April, the online medical journal Public Library of Science
published a study tracking the effect of doctor-detailing by sales
reps working for Warner-Lambert, maker of the anti-epileptic drug
Neurontin. The study showed that, following even a brief encounter
with a marketing representative detailing Neurontin, almost half of
the 97 physicians examined found their briefings highly educational
(even when research evidence presented was scant or poor) and
indicated they would step up prescriptions of the drug.

Dr. Andrew Leuchter has spent much of the last two years heading a
UCLA committee convened to redraft guidelines for physicians’
interactions with drug companies. He has faced the skepticism of
physicians when the subject of drug company influence is raised.

“They ask, ‘Do you really think that my medical decision-making can be
influenced by the fact that someone bought me a pizza?’ ” Leuchter said.

“They’re quite sobered” when confronted with the mounting pile of
evidence that it can, he added.

Subtly powerful
DR. Kurt Stange, the editor of the Annals of Family Medicine who
called for an end to consumer advertising of drugs, said the effects
of a detailing visit can be subtle. But, he added, these encounters
are made all the more powerful when physicians either deny or ignore
their influence.

“You’re not overtly thinking, ‘I’m going to prescribe this drug
because I got a pen,” Stange said. “You’re just thinking, ‘What will
help this patient?’ and you’ve been bombarded with advertisements, and
the name is always before you. . . . You have to have a fair amount of
self-awareness to notice that.”

In the end, advocates of reform say, there is no stronger evidence
that drug marketing influences behavior than the simple fact that drug
companies do market their products — and that they are spending more
money doing it than ever before. The makers of the nation’s
bestselling drugs field on average 4,000 sales representatives to
detail doctors, staff booths at medical meetings and organize trips
and meals for doctors, and spend more than $1 billion per year to
market drugs to physicians alone. They spend, all told, roughly $5
billion a year to advertise directly to consumers. Though they are not
counted in marketing budgets, the funds they dispense to support
research, medical professional organizations and patient-advocacy
groups run into the billions.

In terms of cold, hard return-on-investment, that money was well
spent, says a study unveiled in 2001. Tracking prescription sales for
391 drugs and company marketing budgets from 1995 through 1999,
Dartmouth College marketing professor Scott Neslin has calculated,
down to the penny, how well increases in marketing pay off.

Each additional dollar spent on advertising in medical journals
brought $5 worth of sales of a drug, Neslin found, and an extra dollar
devoted to sponsorship of continuing medical education and
professional meetings yielded an average of $3.56 in sales. A dollar
spent on physician-detailing generated sales, on average, was worth
$1.72. But in the case of the most aggressively marketed drugs, that
dollar generated sales of more than $10.

Appealing directly to consumers was lucrative, Neslin found, but a
little less than wooing physicians. Each dollar spent on
direct-to-consumer advertising generated, on average, increased sales
of $1.37.

Such calculations flesh out a self-evident truth, said, UCLA’s Dr.
Martin Shapiro, a past president of the Society of General Internal
Medicine and an advocate of reform in the relationship: “These are
large and sophisticated organizations. . . . They would not be
spending that money if it didn’t work.”

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Is being overqualified for a position often a problem with Pharmacy
Tech’s? I was passed over for a job recently and I took it to
heart. I called to check on my application and resume I left at an
inpatient pharmacy over a week ago and they said that I
was “overqualified”. So, I asked for clarification. How I took it
is he basically hired a person they could train that was never a
pharmacy tech and not nationally certified to do the same job as I
could for less. I understand we all got to start somewhere but I
don’t fully understand other than we all try to pinch pennies here
and there. I do not put a required dollar amount in the $ field,
instead I put negotiable or neg. I attach my resume to every
application with a paperclip but now I am beginning to wonder if I
should do that? I have noticed around here that most retail
pharmacies pay A LOT less than inpatient. The avg starting pay is
about $7.50, whereas some classmates of mine who are in inpatient
setting or longterm care are making about $9/HR as starting pay.
How can anybody make ends meet with that? Something is better than
nothing I suppose.

Just curious if this has ever happened to anyone else and any
suggestions on how to change this problem. I do not want to
be “underqualified” by any means!

Thanks,

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