Friday, December 28, 2012

Michigan Board of Pharmacy Check Points - August 2012 (with April 2016 update)

Sample of Board of Pharmacy Inspection Points
(OK, this is a bunch of borrrrring text for those few readers used to lots and lots of cartoons...but sometimes, I need to do things that relate to my "chosen profession").  Please bear with me!

In August of 2012, while performing a pharmacy relief ritual in Michigan, I met a representative of the Pharmacy Board who inspected the site I was at and provided me with the following inspection items upon completion of his review, along with the board’s current interpretation of compliance with them.

April 2016 update: Refrigerator logs
Besides looking at daily signature logs and files of recalled products, the current trend in inspections is to check whether the refrigerator in your pharmacy (for drugs only, of course, NEVER for lunch or food) is within acceptable 1-5 degree C range and that the temperature is checked at least on a daily basis.  That means a simple log affixed to the refrigerator, with the temperature noted and an initial of the noter.  Just a head's up!  Of course, we don't know if the same inspections are done for extended delivery times within wholesaler trucks....but that's for another blog discussion!

Is the generic drug supplier noted on the label/receipt?
This is a no-brainer, provided your software is up to grade. Labels should be providing this automatically. I fill in at pharmacies that use SRS nearly exclusively, and they do a great job of keeping the labels filled with the most elaborate minutiae required by pharmacy boards and insurance companies. However, it should be noted that inpatient hospital pharmacies often make use of software that does not provide this information on the labels, labels generally created to fill discharge or employee prescriptions, a function that hospital software vendors may regard as ancillary at best–this may be a setting for procedural violations by the Michigan board.

Does the pharmacist hand initial all new prescriptions?
The initial needs to be on the back of new prescriptions, preferably on or across the software-generated label, with the date of the initial fill or profiling. Also, in the case of filling a prescription that has been previously profiled, the new software-generated prescription label needs to be affixed to the back of the prescription to indicate the date of filling.

Does the pharmacy have all necessary equipment and supplies/references?
The inspector wanted to know about the most current drug information available - specifically, which on-line service for this information does the pharmacy use. This particular pharmacy made use of Facts and Comparisons online, so that was covered. If printed references are used, they should be of the sort that are updated monthly, and the updates should be in place.

Does the pharmacy meet the minimum housing requirements?
This was an eyeball inspection. In essence, are there at least 200 square feet, is the roof secure, and are the rats kept outside.

Are the drugs obtained from legitimate sources, also quality and purity? Expired meds?
If your pharmacy is in the habit of placing ‘return to stock’ meds (ie, those not picked up after two weeks) on the shelf in the original vials, understand that the board interprets the ‘use by’ date on the label to be the expiration for that particular drug. Also, if the pharmacy pre-packs routinely used quantities - ie, Sertraline 100mg, 30ct - the vials need to have the company name, the lot number, and the expiration date. Theoretically, the inspector could also ask to see your repackaging log for these activities. The inspector also uses this item to ask about any files you have regarding drug recalls and whether the pharmacy has had any drugs returned due to recall, and if so, the documentation of that return.

Is the pharmacist using professional judgment when filling prescriptions?
This is geared for pharmacies near physicians who may have become rather casual about the quantities of controlled substances they order. If a physician is ordering 500 Methadone 10mg for a single patient monthly, and is doing that sort of thing for many patients, and the physician is not a world-recognized pain control expert, the inspector may consider routinely, unquestioningly filling such prescriptions to be an example of NOT using professional judgement.

Is the pharmacist counseling first time prescriptions?
Again, this is an eyeball view by the inspector during the visit. Insurance companies (Blue Cross, et al) like to throw this into some of their audits as well, I have noted, and I like to ask such auditors for some identification from the Michigan Board of Pharmacy.

Are there Policy and Procedures for designated tasks? Are they updated?
This is something that was interesting from an independent retail perspective. First of all, you need the policies about specific technician ‘can’ and ‘cannot’ do duties. Then you have to document that the technicians have read and understood these policies. Then you have to document that you have periodically reviewed these policies. Suddenly things felt like a JCAHO survey...

Are CII drugs locked or dispersed?
Well, yes they are.

Are CII invoices in a separate file?
The inspector wants to see the wholesaler files to verify that the controlled substances and the CIIs are all nice and separated.

Are controlled substances invoices dated and initialed?
And by that, they mean, by the pharmacist.

Do all controlled prescriptions indicate the quantity both written and numeric?
These are prescriptions from the physician, not phone orders. If a prescription falls into the pharmacy’s sphere with only the numeric quantity on it, the pharmacy had best be sure to fill in the written quantity, and then document that a call has been made to the physician to verify it.

Do all controlled prescriptions have a hand written signature?
This is still that gray area while e-prescribing and electronic signatures are becoming increasingly mandated at a federal level, but the states are still playing catch up with the technology. The prescriptions must have a hand written signature. If it looks like an electronic ‘stamped’ signature, it should be noted as having been verified by phone, and from whom the verification was obtained.
One further note - if the controlled substance is written by a PA or NP, the prescription MUST have BOTH the names and DEAs of the PA or NP *AND* the name and DEA of the 'overseeing physician.'
So the signature should look like:
Alexis H. Ceasar, NP DEA MC3232321, Dr. Dandy DO, DEA AD1234596
I am waiting word on how this is to play out with extended prescribing authority in Michigan for NPs who will be running their own, independent clinics.

Do faxed prescriptions display all required information - especially the name of receiving pharmacy
This is to protect from multiple pharmacies getting the same faxed prescription. If the pharmacy gets a cover letter to the faxed prescription, ATTACH IT to the prescription.

Do telephone prescriptions identify the sender/receiving individual?
On controlled substances especially, the signature on phoned prescriptions should read something like this: "Dr. Bonzo/Elaine RN/RPh initial." And that pharmacist initial had better be on the FRONT of the prescription - the initial on the back is only to acknowledge the first fill of the prescription.

Is the pharmacy reporting to MAPS
If the pharmacy isn’t doing this, it is presumed that the pharmacy is trying to hide some of its controlled substance dispensing activities. As the software becomes more sophisticated, more and more of the data is being used for tracking purposes of MANY activities. Google "Bob" Patel, Pharmacist, in Michigan to see the results of some of this tracking (and see this link of 1 Feb 2103 for final disposition of the results of the investigation: )
See end of this post for the pharmacies involved...
Is there compliance with the Code of Federal Regulations?
Not sure how the inspector determined this one, but the pharmacy got a pass on it.

Is the pharmacy filing its annual inventory?
This is especially for the controlled substances. Again, this data will eventually get tied to MAPS data to check for variances.

Is the professional license/limitations displayed?
And by displayed, that means so the unwashed, huddled masses at the cash register can see it.

Is the Consumer Information Notice (CIN) displayed?
Ditto above.

Are prescription drugs branded correctly?
That means, can the inspector go to a bag in the pickup bins, open it up, open the vial, and see that the drug brand in the bottle is the drug brand on the label and on the shelf. I guess this is to prevent someone from using any old generic fluoxetine for Serafem.

Well, that’s the world of pharmacy inspections in Michigan as of August 2012. Some of these items seem a bit odd in the 21st century - so many fussy fiddlings with little scraps of paper that are more reminiscent of the 1970s than in the age of the internet...but as I have said, if the Board of Pharmacy stipulates pharmacists wear paisley boxers, it’s time to visit the underwear counter at Sears!

The Patel pharmacies involved in the original indictment were (from : )

Detroit:Caring Pharmacy, 4000 W. Davison
Detroit Care Pharmacy and the Responsible Care Pharmacy, both at a similar address on Mack Avenue
• Four pharmacy store or business names all listed at 19460 Grand River Ave.: Grand River Pharmacy, Friendly Pharmacy, Levan Pharmacy and Kalika Corp.
Prestige Pharmacy on Dexter Road
Glendale Pharmacy on Glendale
Care For You Pharmacy on West McNichols Road

Best Care Pharmacy, 27101 Schoenherr Road
Highland Park Pharmacy, 28001 Schoenherr Road
Rapid Pharmacy, 11664 Martin Road

Bay City:
• Sapphire Apothecary on South Trumbell
• Tri-City Apothecary on Katalin Court
Other locations:
Rapid Drugs, later Noble Care Pharmacy, in Southfield
Independent Community Pharmacy, Dearborn
Taylor Apothecary, Taylor
Be Well Pharmacy, Berkley
Airport Apothecary, with addresses in Waterford Township and Bloomfield Hills
Rx Now Pharmacy, Livonia
Commerce Township Pharmacy, Union Lake, Commerce Township
Eastpointe Pharmacy, Roseville
Preferred Care Pharmacy, Pontiac
Preferred Pharmacy, Troy
Prestige Drugs, Hazel Park
Prestige Drugs Pharmacy, Oak Park
Davenport Pharmacy, Saginaw
Diamond Pharmacy, Kalamazoo

--And add to that, "Tri-Star" Pharmacy in Battle Creek

Monday, October 22, 2012

2016 - Romney's America

OK, so the "documentary" 2016 Obama's America has been polluting the popcorn at the local cineplexi... wonder what a timeline for a Romney version could look like:

            RoveCorp becomes primary consultant to the Romney Administration
            Oil pipeline break in South Dakota pollutes area aquafers and compromises agriculture in the region for three generations
            Conflicts on the Mexican border prompts a "Shoot on Sight" order for illegal immigrants, now labeled "suspected terrorists"
            Office on Mormon Studies opened, designed to retroactively register deceased Americans as members of the Mormon Church
            Abortion outlawed in US by executive order
            Affordable Health Care Act provisions rescinded before many even can take place - millions of citizens under the age of 25 lose coverage on parents' policies; doughnut hole widens on seniors using the Part D program; pre-existing condition restrictions re-emerge
            No replacement program offered by the Republican Party - discussions referred to committee for more discussion
            Education Reform Act under Education Secretary Newt Gingrich institutes a student janitorial work program with lockdown evening dormatories.
            Cantor-Ryan Budget bill passes, privatizing Social Security and making Medicare a voucher program

            All three branches of government fall under the control of the Republican Party, with the party being renamed The American Party
            Patriot Sedition Act passed, Joe Biden held under house arrest
            Florida penninsula water table rises, causing sewer backup in Limbaugh compound
            War on Iran declared after UN loses its neutral diplomatic status and Iranian diplomats arrested
            Gulf pipeline attempted with second disastrous leak created, the entire Gulf coast a fire hazard
            Pay Equality Act allows for women to earn 75% of a man in a similar job, but allows for a 25% tax break on married female incomes over 200K per year
            Natural Resource Conservation Act places an added tax on private users of wind, water or solar energy
            American Citizenship Act passed - Office of Homeland Security is authorized to revoke citizenship of native-born or naturalized citizens who demonstrate "unpatriotic activity," as in protesting the actions of the US government
            Airlines consolidated and nationalized - and then sold as a single monopoly to Chinese interests
            Broadcast Consolidation Act - makes all networks subsidiaries of FOX news; internet access becomes restricted to Homeland Security-approved and monitored ISPs
            Postal Service suspended; UPS and FedEx are nationalized
            First Food Riots
            Admission charged in larger cities to enter grocery stores, with vouchers used at checkout
            Food used as a military recruiting tool
            No replacement program for affordable healthcare act presented for voting - The American Party continues to defer discussions to committees
            Payroll deductions mandatory to support The American Party
            Fires in Detroit, Tampa, and New Orleans from a combination of oil spills and dismantled infrastructure decimate city size and population
            Patriot Dollars replace Federal Reserve Notes at 50 cents on the old dollar.  Ownership of gold and silver expressly forbidden by citizens.
            Gas prices break the $20/gallon barrier
            Oral Contraception outlawed
            Condom sales require a prescription by American Party approved physicians
            Security concerns prompt the Romney administration to move White House functions to a tunnelled compound in Utah
            War declared on Canada over ownership of Yukon territory; Sarah Palin declares herself unelected provisional governor of the region before armed conflict begins.  Most soldiers sent to the Canadian front keep marching inland and defect once they reach Vancouver.
            No replacement program for affordable healthcare act presented for voting - The American Party continues to defer discussions to committees
            Privatized social security and Medicare programs go bankrupt following re-emergence of corrupt practices on unregulated Wall Street.  Most Americans do not hear about the actual cause, only those with illegal reception to BBC broadcasts.  FOX news reports the loss due to "cyber terrorists."
            Elections suspended as War of Armageddon declared
            No replacement program for affordable healthcare act presented for voting - The American Party continues to defer discussions to committees

Sounds like a good 'trailer' can come from this... maybe some animation... some interesting juxtaposition of irrelevant stock footage... could be fun!

Thursday, September 27, 2012

Dreams of the Rarebit Fiend - A Belated McCay Tribute

Winsor McCay's 145th birthday was yesterday, the 26th of September.  Here is a belated tribute to his "Dreams of a Rarebit Fiend" strip, ca 1988 or so...
(c) 1988 The Animating Apothecary
See the whole first volume!

A Day in the Life - Colorized!

Oh the joys of experimentation...
(c) 1999 The Animating Apothecary

Salamander Sketches - from 2001

A trio of test salamander sketches for an art gallery in the northern Mittenstadt.  One of them may have become a t-shirt...

(c) 2001 The Animating Apothecary

(c) 2001 The Animating Apothecary

(c) 2001 The Animating Apothecary

Friday, September 21, 2012

Mrs. Ed - From the 2002 Calendar

Of concern with any woman taking estrogen supplements is the prospect of increased rates of breast cancer.  As this cartoon went into print, the massive estrogen study hoping to demonstrate health improvement among women was abruptly stopped -- when increased breast cancer rates were noted.  Couple that with the lamentable conditions of the perpetually-pregnant horses who serve as the source for many of those estrogens and well, this sketch seemed more prescient than sarcastic... Ah well...

A Day in the Life - 1999

(c) 1999 Animating Apothecary

Homeland Security Helps the Pharmacy Profession

2005 The Animating Apothecary
In the midst of the Bush II administration, it seemed Big Brother wanted to 'help' everywhere....

Inside Joke Cover, ca 1989

MENSA is known for its rowdier moments...the Kalamazoo-Battle Creek chapter published a fanzine-style magazine during the late 1980s called Inside Joke -- and I was asked to create a cover for its edition #69.  Not certain whether all of the Inside Jokes were completely gotten that time around.

Monday, August 27, 2012

Ghosts on Mackinac Island?

Upon closer examination of some photographs taken on Mackinac Island this past summer, there was something appearing at the right of the image.  Thought it worth sharing...
Seemed interesting...

Sunday, August 12, 2012

The FDA Steps Up to Control Narcotic Deaths -- well....

Annual deaths associated with acetaminophen toxicity run about 450 per year.  In 2007, over 11,500 died from hydrocodone toxicity.  Vicodin, Norco, and Lorcet are all combinations of hydrocodone and acetaminophen and are not only heavily abused, but are also implicated in greater numbers of 'accidental deaths' (meaning, abusers who don't make the statistic are accidentally living) each year.
The FDA's response - restrict the amount of acetaminophen in each tablet!
The corporate response?  Abbott, now owners of the Vicodin 'brand' stepped up and made a change in their formulation - no more than 300mg of acetaminophen per tablet (they had allowed up to 750mg per tablet before).  This makes a 'new drug' according to the FDA (a tactic employed by the makers of Tussionex cough syrup for years), and makes previously available 'generics' for 'brand name' Vicodin no longer 'equivalent.'
So a generic company stepped up, got the first approval for a 'generic' and lo - another example of the FDA helping contribute to the rising expense of health care!
The wholesale price of $148.27 is for 100 tablets of this 'generic' for the 'reformulated' Vicodin ES.  Pharmacies could buy a LOT of the old generic, hydrocodone 7.5mg/acetaminophen 750mg for the same price.

Friday, August 10, 2012

2003 Flashback - Dubya's Health Care Plan

So much talk about Obama/O'Romneycare these days...what would that stellar intellect of just one administration ago have come up with?  Oh the possibilities, the possibilites...

(c) 2003 Jim Middleton The Animating Apothecary

Sunday, July 29, 2012

Presidential Morphing - Test 1

Every few months I dust off this project called "Political Asylum" and render out some background elements.  This time the early US Presidents get a working over....

Wastewater Treatment Project ca 2009

The challenge here was getting information about the final required render.  Three years out and I'm not sure if it has gotten much theatrical play!  Oh budgets!

Wednesday, July 11, 2012

Rush Job Redux (1998-2012)

Looking back at this DOS-generated animation piece, with its FLC files and 640 x 480 pixel size, it could only be rendered out by a genlock and VHS interface, with a wild synch attempted with running and recording a 1917 78rpm recording for the soundtrack.
So with the individual GIFS or JPGs that were culled from the original file, it was all re-rendered in complete digital format, into Sony Vegas, re-rendered, then re-introduced into the software with a tweak to shape, a feather to the outline, and a new framing device, namely, an old television. 
Here is the result.
Originally the project took just under 6 weeks of after hours experimentation and hurled abuse.  This time it took 90 minutes to reassemble the images and work out the special effects.  The longest time was in the render, as is usually the case in these projects.

Wednesday, July 04, 2012

Jerry's Wild Moose Chase - A 1986 retrofit

(Featuring long vanished staff from Leila Hospital, back when Battle Creek still had hospitals of its own, in an alternative storyline for another long vanished hospital newsletter, serialized over four months.  Some of the references are just as obscure as they seem, but seemed pretty clever at the time...)



JERRY    Assistant director of pharmacy, closet mechanic, secretly engaged to Princess Caroline
STEVE    His brother, an aeronaut and collector of other men's dreams
MIKE     A licenced pharmacist, part-time cheesemaker and owner of the world's first toothpick
MOLLY  top dog
SID         Cousin to Nanook, born in Brooklyn when his mother began Alaska's first labor protest
RICH      Another licensed pharmacist, also a professional husband
JIM         Claims to be a licensed pharmacist, thinking it will help him meet girls; in actuality, is the defense minister for the Republic of Chad

CHAPTER ONE: Mysteries of the Universe
    It was time for the annual Christmas party and Jerry wanted to do something special for the banquet. In years past, he had delighted his co-workers with his guacamole souffle, his spinach milkshake; and, once in a moment of inspired whimsy, concocted a 17-layer raspberry-lemon torte using e day-old waffles and flavored Maalox. It was easily the hit of the season.
    This year had to be something truly unique. He was thinking about it as he cleaned the carburetor of his snowblower one lazy winter afternoon. Something different, something unique, something worthy of a Good Housekeeping cover. He glanced up in time to see a large moose canter up his driveway.
        "You know," said the moose, "the only cure for boredom is adventure."
    Jerry listened politely (working in a hospital as he did, he was used to seeing some unusual sights, so a talking moose didn't come as all that much of a shock) and started to reply when the moose trotted away, pausing only long enough to ask one of Jerry's neighbors for directions to Alaska.
    Jerry waited a moment or two, just in case some other talking animal should happen by, but none came. He then went back into the house with his almost cleaned carburetor and stuck it in his homemade autoclave (Popular Science project No. 257, June, 1962). The TV was still tuned in to Public Broadcasting and Julia Child was talking about conservation of livers when the screen went blank and the same moose appeared.
    "I hear Pay Streak is a fun place," he said.
    The screen flickered for a moment, and Julia Child reappeared with her livers.
    "This means something," thought Jerry.
    The front doorbell rang. The little boy there was selling subscriptions for his father's fraternal organization.
    "Every magazine represents a $3 donation to the local Moose lodge."
    Jerry said, "Maybe later," and closed the door as the TV switched to an apparent rerun of "Captain Kangaroo" where Mr. Green Jeans was being pelted with ping-pong balls by an overjoyed puppet with antlers. Mr. Moose turned to the camera and said, "Well, Jerry, how 'bout it?" and Jerry said right back, "How 'bout what?" and Mr. Moose said, "How 'bout this?" and Jerry was buried up to his waist in ping-pang balls.
    "What's going on here?" he yelled.
    "Adventure!" said Mr. Moose.
    "Adventure!" said Julia Child.
    "We're about to land!" said the stewardess.
    Jerry wiped the grit from his eyes and looked out the window on the frozen white of Alaska. The stewardess was still talking to him.
    "We still have some extra desserts, if you'd like another."
    "Don't tell me---chocolate mousse?" asked Jerry.
    "How did you guess?"

CHAPTER TWO: Alas and Alaska
    A team of huskies pulled alongside Jerry as he watched his plane take off.    The sled's driver looked familiar.
    "Mike!" said Jerry. "What are you doing here?! You're supposed to be covering for me this weekend!"
    Mike readjusted the hood of his parka. "What are you asking me for? This is your dream, isn't it?"
    "I woke up on the airplane." One of the sled dogs sneezed and excused itself. "At least I think I did."
    "OK, so you want reasons? I thought I should get out more so I took on a paper route."
    "In Alaska?"
    "Hey, I don't write this stuff. You want a ride or don't you?"
    "In that? Where ya headed?"
    "Pay Streak. I've got their monthly allotment of freeze-dried women. You didn't happen to bring any live ones with you?"
    Jerry was looking at the little uniforms on the huskies. Some of them had stenciled sayings on them like "Death to Hairballs" and "Dogbreath is good for you."
    "What?" said Jerry.
    "How 'bout recipes? They'll take recipes. Do you remember the one for that 17-layer torte?"
    Jerry tried to concentrate on the recipe but could only think of Julia Child and her livers. "Sure. No problem."
    "Great," said Mike. "Hop on. And whatever you do, don't sweat."
    Jerry found that he was sharing space with one of the huskies. He scratched it behind the ears.
    "If you're going to do that," it said, "move lower and to the left."
    Jerry continued scratching the huskie for several miles while Mike pointed out landmarks.
    "Over here we have a glacier, and over there we have a glacier, and just past that ridge there, we have a really big glacier. The guys at Pay Streak usually name them after old girlfriends."
    A brisk northerly hit the group.
    "What do you call that?" asked Jerry.
    "We call the wind Maria."
Jerry shuddered and returned to the huskie.
    "How much longer do I have to scratch your back?" he asked.
    "Just until I lick your face."
    ...and over there is the Anita Iceberg." Mike stopped the sled.
    The huskie jumped from Jerry's lap and joined the other animals in what looked like a game of canine musical collars. The odd dog out hopped onto the sled as it hit the trail again.
    "Molly tells me you give a mean back rub,"he told Jerry. "Easy on the shoulders and don't be stingy with the ears."
    "No baby oil?"
    "What? And ruin my perm?"
    Pay Streak had a population of 417, not counting the pet rocks. Most of the inhabitants were male, and at least one of the males was related to Jerry. His name was Steve, and he ran one of the most prosperous enterprises in Pay Streak; namely, the airplane that could get you out of town. Through a union agreement, Mike's dog sled could only arrive but never leave. This explained why Pay Streak also had 417 dog sleds.
    Leaving town became a priority usually after a crooked Yahtzee game (second Tuesday of the month) or when someone tried to break into the warehouse containing the freeze-dried women. Whenever either of these things happened, the other inhabitants would pursue the culprit and set upon him with their pet rocks. It was not a pretty sight.
    After working only a few months, Steve had been able to salt away enough to put down payment on Utah. "I'm going to drain that lake and fill it with Mic Lite. Make it the Great Malt Lake," he told Jerry that night.
    "Glad to see the cold hasn't affected you any," said Jerry.

CHAPTER THREE: Pass the Northern Lights, Please
    Jerry fumbled for a flashlight just as his brother called for a second time. He found a wet nose.
    The huskie slowly got to its feet. "You're one to complain," he said. "It's bad enough that you hog the blanket, but you snore off-key, too." "Sorry."
    "Don't sweat it, big fella. Now be a good boy and fetch me a breath mint or something, will ya? My mouth feels like it's been sucking on a milkbone all night."
    Steve almost had breakfast ready by the time Jerry was dressed.
    "I thought I'd surprise you and try that 17-layer torte you told me about," he said. "I had to substitute Alternagel for Maalox, though."
    Steve set out the day's itinerary while they ate. They were to meet their Eskimo guide at the supply station at noon, have lunch, take a nap until three, then fly north about ten miles for dinner at Last Chance Macs', and crash for the night.
    "I take it that's a figurative -crash,'" said Jerry.
    "Usually it is," said his brother, "but bring a book just in case."
    At the supply station, they met up with their Eskimo guide, Sid, introduced as Nanook's cousin from Anchorage. They also stocked up with a month's worth of Beer Nuts and got a credit slip for their fresh water supply. Jerry began to entertain suspicious thoughts when the man behind the water counter appeared, sprouting a fake nose and glasses, near standard garb in those days among pharmacists living in and around Battle Creek (dubbed by Better Homes and Underwear as "The Surreal City for the 50's").
    "Rich!" said Jerry. "Is that you?!"
    The young man's eyes widened in horror and he recoiled, falling over a case of instant water and cracking his fake nose.
    "No, I'm not Rich," he said, "and even if I were, I wouldn't be here because I'm supposed to be home mowing the lawn."
    "OK, OK, so you're home mowing the lawn? Who's working the pharmacy?"
    "Well, I traded with Mike."
    "But Mike's here!"
    "Then you must be dreaming," said the man who wasn't Rich but probably was.


    Jerry, Steve, and Sid took off just on schedule according to Eastern Standard Time, gashing one of the plane's pontoons on an incoming spur of the Alaskan pipeline. Liquid bubbled from the damaged pipe, staining the surrounding snow.
    "Oopsy!" said Steve. "There'll be a letter to the editor about that tomorrow."
    "Is it oil?" asked Jerry.
    "Worsen that," explained Sid. "It's that new formula Coke. Those guys had to send it somewhere."
    The trio touched down at Last Chance Macs' and Sid explained the subtleties of moose hunting over a mound of blubber burgers.
    "Well, ya got yer Moose Encounter of the First Kind. That's where you see your basic moose. The antlers, big schnozz, ya know, yer basic moose. Then ya got yer Moose Encounter of the Second Kind, where ya get yer physical evidence."
    "What kind of physical evidence?" asked Jerry.
    "Just check your shoes every now and then," said Sid. "You'll get the picture."

CHAPTER FOUR: Behind Every Gray Man is a Woman
    A few days later, Jerry, Steve, and Sid were huddled around a pot of brewing Maxwell House while the wind howled the third movement from Beethoven's Fifth.
    "Why are we drinking all this coffee?" asked Jerry.
    "We've gotta stay awake until just before daybreak," said Steve.
    "And when's that?"
    "Two months," said Sid.
    The howling dropped an octave and changed to the key of C-sharp. The dogs joined in. The wolves followed suit. The moon folded with a pair of Jacks.  The dish ran away with the spoon. Jerry turned to his brother.
    "Did any of that make sense to you?"
    "No, but then, I'm only on my third cup."
    "Stop it! Stop it!" screamed Sid. "All this chatterin'! All these woids! Can't youse guys communicate wit'out cloggin' my ears, my brains, my very BEIN' with yer unrelentin' yammerin'?"
    "Sid," said Steve. "I think you're overacting."
    "Can't youse guys just stare at the fire and drink yer coffee like the rest of us?!"
    Jerry and Steve looked around. "The rest of us, Sid? We're the only ones here."
    "Oh, fine. Ignore my friends. Just because they have tusks."
    "Sid..." said Jerry.
    "You think it's some bed of cherries bein' a walrus?"
    "Sid..." said Steve.
    "You try balancin' a ball on that honker of yours sometime, you think you're so smart."
    "I don't need to stay here and put up wit' this." Sid stormed out into the arctic wilderness.
    Jerry and Steve looked at Sid's shrinking figure, then at each other, muttered "overstimulated," and dumped their coffee.


    Back in Pay Streak, great things were afoot. The new formula Coke spill had set up a thermal inversion causing the hamlet's first recorded rainfall in thirty years. The rainfall then exposed a hole in the roof of the town's main warehouse, the warehouse that stored the spare Yahtzee score pads, the extra pet rocks, the freeze dried women...

    Jerry and Steve were still back at camp, fighting over a belt.
    "Look," said Steve, "you don't need it up here."
    "But it's leather," said Jerry. "If we run out of food, we can boil it up for supper." Jerry reflected on that prospect for a moment. "On second thought, I'd rather eat my foot. Here."
    Steve emptied the coffee can and ran the belt through it.
    "Now watch this," he said.
    Steve spit on his fingers and stroked the strap. The can squeezed out a dull moan. Jerry was unimpressed.
    "That's supposed to be a moose call? For that I risked having my britches drop at any moment?"
    "Let me tighten things up a bit," said Steve.
    He tried again. This time the can squeaked out, "And now here's Mr. Know-It-All." At least, that's what Jerry thought he heard, earmuffs being what they are and all. But sure enough, a few seconds later a moose appeared.
    "Hey, Rock, watch me pull a rabbit out of my hat," it said.
    "Again???" said Jerry and Steve.
    "Nothing up my sleeve--PRESTO!" The usual polar bear appeared.
"I think it's time we headed back," said Steve.
"I think you're right," said Jerry.
"Normally, I take a size seven and a half," said Bullwinkle.
"We know, we know."

*    *    *
    Steve and Jerry returned to a ghost town. They wandered the deserted streets of Pay Streak until they came upon the shredded remains of the main warehouse. A gaunt spectre of a man seemed to be the only person around.
    "Middleton!" yelled Jerry. "You too? Isn't there anyone in the pharmacy?"
    "Naw," said Jim. "Cost containment. The hospital was taken over by Christian Scientists, and now they just give everyone that comes in a Bible. And they steal those from hotels. Everyone is selling Star Wars posters now."
    "Well..." Jim shifted his weight from foot to foot. "I was made a Vice President."
    "Yeah, I sorta lost the negative response questionnaires to the employee's satisfaction survey, so now I'm in charge of the animation department at the hospital. The administration hopes to increase patient enrollment from Tunis."
    Steve looked around. "Have any idea what happened here?"
    "I got in just as the dust was settling," said Jim. "Seems that there was a rainstorm that reconstituted the women in the warehouse all at once, and they didn't waste any time in making the guys put away their Yahtzee pads. It looks like all the pet rocks were turned into that big rock garden just over there by the clearing, too."
    "But where did everyone go?" asked Jerry.
    "The gals all made the men take them back to civilization and enroll in college to become CPAs."
    "So why are you here?" asked Steve.
    "I kinda messed up on my tax report and checked that I was married and had seventeen dependents."
    "Seventeen dependents?"
    "So my pen slipped. Anyway, I figured I could try to make up the slack by popping by here, but Rich took off with all the extras before I could arrive. He said something about needing help mowing the lawn."
    "Why didn't you try that secretary of yours--what's her name--Kudra?"
    "Oh, that's another story. She really got into that stack of Cosmos from the girl's locker room and now she's starting up a commune for repressed women with a Rambo fixation."

    Just a few words later, Jerry was back in his kitchen, still trying to come up with a recipe for the Christmas party. The best he could do was a freeze-dried lemon mousse that rehydrated itself when you sweated over a hot stove.
    "Too salty," was his verdict.


A History of Pharmacy - Until 1997, at least...

Flashback to 1981 - The Battle Creek International Balloon Festival

For the first few days of the international ballooning festival, I played keeper to one Stan Donovan, an acquaintance from my college days who went on to become an itinerant events reporter for such pillars of literature as High Times, the Cosmic Experience, and, in his more lucid moments, the Rolling Stone. When he left, I found some of his notes stuffed into a half-empty case of Rebel Yell. I have pieced them together for what follows, with his approval, of course.

June 20, '81 OPENING DAY
Battle Creek. The Best to You Each Morning. The place reeks of cereal. I wake this afternoon to the smell of burning Froot Loops and have to scrape the sugar coating off my windshield before I can leave for the airport, praying to the goddess of gasoline that I have nothing besides a tiger in my tank. The car, a rusted black market rental I got in a trade for three hot Visa cards, dies anyway, lunging one final yard before spilling its transmission onto Territorial Road, just blocks from the launch site. It's just as well. Two hundred thousand beings are there already, pressed against snow fences, huddled in overheating cars, piled on mopeds, falling off bicycles, most of them stoned on hot dogs, crusty mustard, and Sno cones...
I spend a good thirty minutes studying the traffic patterns around the airport. A uniformed Cambodian refugee is conducting those same overheated cars and mopeds into bloated parking areas with the grace of a fine chef brandishing his Ginsu. Six jets roar overhead, dive bombing the city's north side. They are the Thunderbirds—six red, white, and blue T-38 Talon jets, flying billboards for the Air Force. They can singe the hair on the back of your neck and be over the horizon before the smell hits you. They pass by once more, trying to scare the lookout tower. Two fellow reporters, one from the Spokane Post-Examiner, the other retired from the Blue Network, get whiplash on the spot. They are ushered into the nearby aid station, a self-proclaimed M*A*S*H* unit equipped for handling hangnails to Caesarian deliveries, but rendered impotent against an epidemic of Elephant Ear Enteritis. This locally-coined medical term requires some explanation.  It seems, with the appearance of the balloons, came the arrival of a grease-stained delicacy called Elephant Ears, a tidbit resembling a pita bread dusted with a coat of cinnamon. They act on the body much like a Roto Rooter. I can see them being created, pioneer-style, in the back of the Official Elephant Ear Wagon. No flapless Dumbos there--just a combination of flour, lard of indeterminant age or origin, and occasional hair. The hair seems to be the active ingredient.
I drops fifty milligrams of Dramamine and head to the field.
While the guard at the press gate is telling me that Reagan has sent his wishes for fair winds, a hot mist comes up from the southwest, turning the airstrip into fifteen acres of hazy meadow. Politicians should stick to politics. someone mentions canceling the evening's mass ascension. He is lynched quickly, quietly. This crowd means business.
The pilots appear now, marching in file, freshly briefed on the weather, and appraised of new red zones, chunks of Calhoun county where farmers will meet them with open pitchforks if they land. The masses divide for them, applauding. Once again, Man Will Conquer The Skies. Kitty Hawk, Cape Canaveral, and now, Battle Creek. Do I detect the National Anthem.
I am jolted from my reverie by a telephoto lens to the left kidney. The Japanese film crew has arrived...
I count about seventy-five ballons getting into position now, the silken enveloped pulled into place, the crews making them quiver and pulsate with jets of cold air. Then the propane is fired, and the American Dream is airborne with vivid colors extolling me to drink Smirnoff, eat at McDonald's, and read Playboy. I ache to comply.
A press balloon springs a leak, deflating in a heap nearly on top of me, so I stay behind, watching these ethereal teardrops defy gravity. They head to the northeast, their ground crews hastening to keep pace.
I dissolve into the crowd when my car is announced as a traffic hazard over the P.A.
A recorder picks up the following conversation between two ladies wearing "Bomb California" buttons:
"I don't see how Kellogg's could let that Playboy balloon in on this," says one.
"I think I'll write a letter," says the other.
"And did you see that girl they had here? Practically falling out of that little outfit."
"Just indecent."
I am about to say something, but notice they are standing in line for Elephant Ears, so I just smile and walk on.
The Exodus pushes me on in time for me to watch as my rental is towed away. Requiescat in pace.. I still have a dozen Visa cards....

I come upon one of the chase crews held up in traffic, and, seeing a chance for escape, hitch a ride. Ground control is giving chase vehicles     priority on the roads, but this driver hops the curb and heads cross-country anyway. I scrutinize my travel companions. The pilot of the van calls herself Bubbles and is navigating with a revoked license. Her nine-year-old daughter is passing around a diminishing six pack of generic beer. The third crew member turns out to be a stringer for ESPN who needs a landing shot to complete his report and who, like me, saw the chase van as the only way of escaping the crowds before midnight. The last inhabitant, buried beneath the portable videotape equipment, happens by some coincidence to be my Battle Creek host, a disgruntled pharmacist who thinks that some questionable ability will get him into films. The stringer and nine-year-old are seeing who can get him drunk first.
Bubbles then announces that she has lost our balloon and stops the van.
Her daughter quickly produces a map of Calhoun county, complete with Red Zones, add the stringer points out routes guaranteed to have us lost within minutes. The pharmacist struggles from beneath the videotape equipment and tells us that we've just parked in someone's front lawn. The daughter pats him on the head and gives him another beer. I suggest we continue northeast, the general direction the balloons seemed heading. The vote is three for, and one against, with the one abstaining member quickly becoming comatose.
By now, the police scanner is posting updated ABPs on a renegade chase van, so we return to the charted roadways. The Norwegian and Danish balloons gently collide above us. The mist is getting thicker. Also sweeter. Kellogg's is near.

Bubbles stops at the factory to get our bearings. her daughter again produces her maps and my Battle Creek host wanders over to the main entrance to begin an animated repartee with the ceramic Tony the Tiger standing sentry.
Abruptly, the Hong Hong entry, guided by an Austrailian, lands in the parking lot not fifteen feet away. Its chase crew springs from a nearby billabong and has the balloon wrapped, packed, and shunted away before we can even get in a good chorus of "Waltzing Matilda." Bubbles stands in awe, the nine year old says"Whoa, Man," and the pharmacist doesn't notice, his conversation with Tony having degenerated into a corruption of Canadian French and Pig Latin. ESPN loses its exclusive report when the stringer can't dislodge a beer tab jamming his controls on fast forward.
The haze becomes a fog and we answer the call of the open road.  When an hour passes and we haven't heard an update on our position over the scanner, we realize we are lost. Our road has gone from gravel to a two-track to a field where a pony cantered through perhaps a week before. Bubbles stops the van. As near as we can estimate, we are in a Red Zone. "I am not enjoying this," she says.
She slams the gears into reverse, and we retreat about five yards when there is a metallic Ching and the front of the van sinks. A tire is dead, victim of a bear trap.
Now, it has always been my conviction that the presence of a bear trap in a Michigan field is not a good amen. For one, I don't like traps. For another, I don't like bears. I don't like to watch them wrestle Dan'l Boone, I don't like to lie on their rugs. I'm sorry. I'm just that way.
The pharmacist grunts a chorus to "La Boheme" and enters REM.
Dusk is setting in, and we can barely see the last of the entries drift over the trees to the northeast. Nor are we alone. The mosquitoes have discovered their free lunch. Between slaps, the stringer tells me how he was trapped in a blizzard and proceeded to videotape his last will and testament. Bubble's daughter is sitting on a rock, chanting, “Lions and tigers and bears, oh my." Her mother is wishing that her flashlight worked.
I begin to go quietly out of my mind.
An owl and two bats lend themselves to the scenario as my body temperature drops eight degrees.
Lions and tigers and bears oh my.
We pry off the flattened tire and the stringer takes it to the back of the van. I hear a thud.
Then silence.
Lions and tigers and...
The grass crackles.
...bears oh my...
Bubbles and I run to the back but see nothing. No stringer with a flat tire. No pharmacist behind the rear wheels. She calls out for her daughter.
I run to the cab and find the faulty flashlight. It flickers when I give it a good whack against the van. Come on, light up. The bulb dies again.
I run back where I left Bubbles. No more Bubbles.
...and tigers.
I hear something walking around me, stalking me.
...and bears.
The grass crackles again.
...oh my.
Madness helps at times like this. I yell like a stung hyena and run for the cab. For a moment, it works. I think I can make it.
Then it is on me. I'm knocked into the grass and it has me by the legs, pulling itself over me. I can feel it drooling, panting, its dank breath taking mine...
The flashlight.
I swing at it with the flashlight, making contact with a dull crack. The light comes on and I can see it now, arching back slightly from the blow. It starts to laugh at me, a low rumbling laugh
that grows and pushes me back. It looks like it's wearing a mask...
An elephant mask.
It lunges at me, and just before everything goes out, I wonder where its ears are...
I wake up on my back, staring into a bright light, smelling of Witch Hazel and iodine. A  Mephistophelean character peers at me, says something to a girl near him, and she leaves. My host, the comatose pharmacist, appears with my camera and recorder. I grab his shirt.
"You sure he just hit his head?" says the doctor.
My host says I'm always like this. I'll get him later.
"Get me out of here," I say. "That guy looks ready to do some quick surgery."
Outside, I am told that when the press balloon collapsed on me, I wandered away and became entangled in one of the ascending balloons' ground ropes and was dropped on my head from ten feet. Another plot, I'm sure. I check my arms for needle marks, some sign of drug entry, then I remember...
The elephant ears.
I run into the crowd as my car is announced as a traffic hazard over the P.A. I cannot maintain....

Friday, June 01, 2012

So Hard to Raise Parents

It has been a year since the passing of my father, Harry Middleton.  And since he died on Memorial Day, it's only appropriate that especial attention should have been made of the event.  First, we began with my mother, who died just before Labor Day in 1986, by dressing up her site:
Then to Harry's location, among a strip of Middletons north of Big Rapids, Michigan...

His ashes were interred the same day as his sister Pauline's, whose passing came barely two months following his.  So after some fussing and arranging, some red/white/blue themed artificial flowers and perky decorations were assembled and put in place:

Content with the outcome, we left the site, to find this sign:
Uh oh... we had gone 'artificial'....and worse:

This is one Puritanical burial site! Of course, dad would have argued that if you can't spell 'alcoholic' properly, one shouldn't have to follow the instructions.  But we did, drove down the road and found a convenient organic greenhouse selling geraniums and baby chicks.  We opted for the plants:

But now, what of the extra faux plantage?   Well, Harry is technically available for viewing at two locations, so we went back to Lakeview, Michigan and said hello to mother again:

And the world once again could spin in greased grooves.......

Thanks for stopping by... here's to remembering friends and other loved ones this and every holiday...

Sunday, May 27, 2012

Wanda Brooker 1928- 2012

Wanda Mae Brooker

Battle Creek

Wanda Mae Brooker, 84, of Battle Creek went to be with her Lord and Savior on Friday morning, May 25, 2012. She was born February 28, 1928 in Wabash, Indiana the daughter of Harlow F. and Hazel B. (Harden) Andridge. The family moved to Battle Creek in 1934 and Wanda graduated from Battle Creek Central High School with the Class of 1946.

Wanda faithfully worked at the Lakeview General Osteopathic Hospital from 1957 until its closure in 1985. She then worked as a receptionist at Lathrop Construction Company until she went to work for Rite Aid Drug Stores as a Pharmacy Technician in 1987 until she retired in 1999.

Wanda married Alvin N. 'Al' Brooker in Battle Creek on August 17, 1946; he sadly preceded her in death on August 30, 2003. She is survived by her sons, Theron 'T' (Dianne) Brooker of Battle Creek and Martin 'Marty' (Loretta) Brooker of Battle Creek; 5 grandchildren, 6 great­grandchildren; 2 great-great grandchildren; a sister, Dorothy Cronkhite and several nieces and nephews. Wanda was also preceded in death by her parents; a son; a brother and a great-grandson.

Wanda was a member of the Trinity United Methodist Church. She truly enjoyed camping, reading and loved spending time with her family.

A graveside service to celebrate Wanda’s life will be held 11:00 a.m., Tuesday, May 29, 2012 at Memorial Park Cemetery. In lieu of flowers, please consider making donations to the Humane Society of South Central Michigan. Arrangements were made by the Farley-Estes & Dowdle Funeral Home. Personal messages for the family may be placed at

Monday, May 21, 2012

A Rather Disturbing Trend in 'Medicine'

A recent link from "Physician's Money Digest" is as follows.   I find it at least disturbing that the article celebrates the profits that can be had in treating cancer, and how it can offer the information to physicians who might be willing to benefit from judicial investments.  I contend that a logical sequel to this would be a listing of the 10 Most Profitable Mortuary Chains.
Here's the article:
10 Best-Selling Cancer Drugs
Right now oncology is the main attraction, which makes sense considering ASCO is just two weeks away. But oncology drugs have always garnered a lot of attention because the diseases they treat are so scary for the patients, plus they can be quite costly. (italics mine)

But the good thing (for the pharmaceutical companies) is that these drugs aren’t facing generic competition like some other drugs have to. As a result, expensive and older treatments are contending with low-cost generics for sales, meaning they’re still bringing in a pretty penny for the company
. (emphasis mine - again, what are we celebrating here?  More effective treatments?  Or more expensive - and thus, profitable - treatments for drug companies?  And are any of these treatments more effective, or just more profitable?  And isn't it just about the creepiest thing to consider success not by outcomes, or benefits to the patients, but as profit from sales of these drugs.... what a world, what a world... )

FiercePharma released a list of the top 10 best-selling cancer drugs based on how much they brought in U.S. sales over the last year. (My interruption again:  they also have a nice discussion on whether drug company CEOs get paid enough!!! So far their newsletter is free, so go there and get the daily scoop on what PharmaLand is doing behind the curtain)....
(And look how the information is presented, like it's some Top Ten on the David Letterman Show)
10. Tarceva
2011 sales:
$564.2 million
FDA approvals:
Non-small cell lung cancer, 2004; pancreatic cancer, 2005; NSCLC maintenance therapy, 2010.

9. Xeloda

2011 sales:
$647.6 million
FDA approvals:
Metastatic colorectal cancer, 1998; metastatic breast cancer, 2002; adjuvant colon cancer therapy, 2005.

8. Velcade

Millennium Pharmaceuticals, a unit of Takeda Pharmaceutical Industries, in partnership with Johnson & Johnson
2011 sales:
$692.7 million
FDA approvals:
Multiple myeloma, 2003; mantle cell lymphoma, 2006; first-line multiple myeloma, 2008.

7. Erbitux

Eli Lilly, in partnership with Bristol-Myers Squibb
2011 sales:
$703.3 million
FDA approvals:
EGFR-positive colorectal cancer, 2004; second line in head and neck cancer, 2006; first line in recurrent or metastatic head and neck cancer, 2011.

6. Alimta

Eli Lilly
2011 sales:
$1.04 billion
FDA approvals:
Malignant pleural mesothelioma, 2004; non-small cell lung cancer, 2008; NSCLC maintenance therapy, 2009.

5. Eloxatin

2011 sales:
$1.2 billion
FDA approvals:
Colorectal cancer, 2002; adjuvant use in colorectal cancer, 2004; new formulation, 2005.

4. Gleevec

2011 sales:
$1.51 billion
FDA approvals:
Chronic myelogenous leukemia, 2011; gastrointestinal stromal tumors, 2002; Philadelphia-chromosome positive acute lymphocytic leukemia, 2006; dermatofibrosarcoma protuberans, 2006; certain myelodysplastic/myeloproliferative diseases, 2006; hypereosinophilic syndrome/chronic eosinophilic leukemia, 2006; aggressive systemic mastocytosis, 2006; adjuvant GIST treatment, 2012.

3. Herceptin

2011 sales:
$1.66 billion
FDA approvals:
Metastatic HER2-positive breast cancer, 1998; adjuvant in early-stage HER2-positive breast cancer, 2006; additional adjuvant approvals, 2008; HER2-positive gastric or gastroesophageal junction cancer.

2. Avastin

2011 sales:
$2.66 billion
FDA approvals:
Metastatic colorectal cancer, 2004; non-small cell lung cancer, 2006; breast cancer, 2008 (revoked in 2011); kidney cancer, 2009; brain cancer, 2009.
AND HERE'S NUMBER ONE - The drumroll, please!!!!
1. Rituxan
Company: Genentech
2011 sales:
$3 billion
FDA approvals:
Non-Hodgkin lymphoma, 1997; rheumatoid arthritis symptoms, 2006; rheumatoid arthritis disease progression, 2008; chronic lymphocytic leukemia, 2010; Wegener's granulomatosis and microscopic polyangiitis, 2011.

Ka- CHING!!!!!!

Fallout from the Calendar archives...

That's about how I recall January of 2009....

Illustration compilation at lulu press.  Here's the link:

Sunday, May 06, 2012

The Not Quite Wright House - Galesburg, Michigan

Southeast of Galesburg, Michigan, is a collection of five homes on a little side street called Hawthorne.  The Woods entryway is distinctive, and moreso when it is revealed that the little area was designed by Frank Lloyd Wright.  Four of the homes bear the direct Wright design - and one other, nudged off on a side spur, was by Taliesin Schoole fellow Francis Will Willsey.  Its 1442 square feet are up for grabs, and its asking price of $99K, amid the surrounding designs, seems like a bargain, but this is a case where possession could be 100% of the loss. 
The poor place has been empty over three years, and even before that, the reclusive first-owner seemed to struggle with maintenance.  It's possible to see how things may have been, but the damage by neglect is substantial. 
What was striking on just driving up to the property was the smell - a damp, moldy smell of an overmoist basement.
And once around the curve of the driveway, the open carport reveals plywood storage doors, their laminant warped...

The entryway exhibits the Wright style of low ceilings that open into a 'great space' (here, the combined living and dining room), but the damage is there as well.

The main living area has been worked on to repair ceiling leaks, but any woodwork has fallen victim to the effects of moisture. 

The vaulted ceiling continues to link this area to the kitchen, which has had some recent repairs and renovations - new appliances and countertops...

And off the living area is a long hallway, with a bathroom and two bedrooms on the right and a row of storage cabinets on the left.  All of the cabinet doors are damaged, one is missing....

The unfinished cinderblock construction, even on the inside, almost gives the impression of being in a bunker.  The partially submerged design reinforces the feeling.  Nevertheless, it's in such a sweet natural location with serious history nearby that someone with the money for the home, and an additional $99K for renovations, would be in constant contact with mother nature.

(Not much to do with animation, or apothecary even, but it was an interesting roadtrip this Sunday afternoon!)