‘THE MOST DANGEROUS TYPE OF PHARMACIST TO THE CHRONIC INTRACTABLE PAIN CARE PATIENT “THE PHARM D. PHYSICIAN WANTS TO BE”

BY

NORMAN J CLEMENT RPH., DDS, NORMAN L.CLEMENT PHARM-TECH, MALACHI F. MACKANDAL PHARMD, BELINDA BROWN-PARKER, IN THE SPIRIT OF JOSEPH SOLVO ESQ., IN THE SPIRIT OF REV. C.T. VIVIAN, JELANI ZIMBABWE CLEMENT, BS., MBA., WILLIE GUINYARD BS., JOSEPH WEBSTER MD., MBA, BEVERLY C. PRINCE MD., FACS., LEROY BAYLOR,   JAY K. JOSHI MD., MBA, ADRIENNE EDMUNDSON, ESTER HYATT PH.D., WALTER L. SMITH BS., IN THE SPIRIT OF BRAHM FISHER ESQ., MICHELE ALEXANDER MD., CUDJOE WILDING BS, MARTIN NDJOU, BS., RPH., IN THE SPIRIT OF DEBRA LYNN SHEPHERD, BERES E. MUSCHETT, STRATEGIC ADVISORS

THE PHARM.D PHYSICIAN WANT TO BE

“THE CHRONIC PAIN PATIENTS AND PRESCRIBING PRACTITIONERS WORST NIGHTMARE”

INSPIRED BY POPE FRANCES AND THE LITTLE GIRL:

“These Pharmacists have  failed to recognize a people’s chronic disease conditions of intractable pain, while further failing to understand or comprehend human suffering, the science of clinical medical treatment and the value of human life.”

DOCTORS DON’T DECIDE IF YOU NEED IT, PHARMACISTS DO!!! 

Exposing “The Uncomfortable Pharmacists”

The practice of the “uncomfortable pharmacist” in withholding treatment of a patient by altering or denying medications is both dangerous and unacceptable in the field of medicine; it has resulted in patients’ suicide.

However, what makes these Pharmacists even more dangerous is their opinions and reasoning are base on the foundation of CDC’s flawed Unscientific Opioid prescribing Guidelines developed under unreliable data to which the CDC has admitted to being seriously flawed.

Ms. Katherine Rosenburg-Douglas writes:

“Last month, I dropped off a prescription before I started work at 7 a.m. on a Sunday, and the pharmacist said she’d need to speak to the doctor so I probably wouldn’t get it until Monday. I had my doctor paged at 6:30 a.m. Agonizing hours passed before I called and pressed for the reason.

AMERICA MEDICAL ASSOCIATION (AMA) LETTER TO CDC DEBORAH DOWELL MD., JUNE 2020:

“Therefore, it follows that a dedicated effort must be made to undo the damage from the misapplication of the CDC Opioid Guidelines.

She told me there were “great distances involved,” between my address, the doctor’s office, and where I was visiting my parents for the weekend — although they’re all about a 45-minute drive, pretty standard for Chicagoland.”

“It’s suspicious,” she said.

“I DON’T FEEL COMFORTABLE”

Furthermore, pharmacists’ attitudes have their etiology in a belief that they have a corresponding responsibility which in fact requires them to operate within the field of medicine in giving a second opinion; thus undermining the diagnosis and treatment plan of the prescribing practitioners. 

THE “UNCOMFORTABLE PHARMACIST,” THE MOST DANGEROUS AND MIS-INFORMED PHARMACIST!!!

Pain and pain management is a very complex issue.  More often than not in chronic (non-acute) pain which is considered a disease, comorbidities need to be addressed.  The “uncomfortable pharmacist,” has failed to develop a basic understanding of pain pathophysiology and neuroscience and the basic structures and function of the Nervous System which is a complex structure that coordinates voluntary and involuntary actions by transmitting signals to and from different parts of the body. 

THE PHARMACIST ROLE IN DISPENSING OF A PRESCRIPTION

UNIVERSITY OF MARYLAND DENTAL PHARMACOLOGY PROFESSOR AND PHARMACIST RICHARD L. WYNN RPH, PH.D.

Pain is a complex and subjective experience initiated by an unpleasant (or noxious) stimulus associated with actual or potential tissue damage. Pain is a primitive response that motivates us to withdraw from the source that is causing the pain and protect the body from further damage.  The unpleasant feeling associated with pain is also stored in our memory so that we can avoid similar situations in the future. While seemingly intimidating, its understanding is not all that difficult. 

The truth is that overprescribing has no definition, is not a medical term, and has not been proven that substance exposure alters any aspect of the “opioid crisis.” In fact, patients on long-term opiate therapy for pain stabilization are the least likely to overdose on their medications. 

Richard Lawhern PH.D.___

“Morphine Milligram Equivalent Daily Dose (MMEDD) is not a useful measure in defining limits on opioid dosage and as such, it has been repudiated by the American Medical Association(AMA). Its major utility is as a rough guide to the clinician in making a safe transition from one opioid to another.”

Its origins have further become grounded in positioning hospital medical politics, “power-hungry egos” to elevate the pharmacy profession out from images of just being in the basement of a hospital dispensing and compounding to a clinical role on the healthcare team. However their maleficent has resulted directly in pain care patients’ suicides and the increased use of illicit counterfeit street drugs.

FAILING TO SEE SUFFERING

NORMAN J CLEMENT, PHARMACIST, DENTIST Acute Allergic Reaction to Embalming Fluid 2015

In these cases, the pharmacist acts by using no sound scientific materials to support their “uncomfortable foundation.”

  1. The pharmacist does no physical examination on the patients.
  2. The pharmacist reviews nor orders any lab work. 
  3. The pharmacist reviews nor orders additional radiographs and views no progress report. 
  4. The pharmacist further fails by entering nothing into writing as to the decision of how they determine the prescription(s) to be illegitimate and why they’ve interjected themselves into the practitioner-patient relationship by withholding or denying patients their medications.

“ The American Medical Association strongly supports a pharmacist carrying out his or her corresponding responsibility under state and federal law, but the past few years are rife with examples of patients facing what amounts to interrogations at the pharmacy counter as well as denial of legitimate medications” 

THE TRAUMATIZING OF THE AFFLICTED

PHARMACIST PROFILING OF PATIENT

NOT THE PURVIEW OF PHARMACIST TO INTERROGATE OR CHALLENGE THE PHYSICIAN DIAGNOSIS

JOSEPH L.WEBSTER, SR., MD, MBA, FACP, BS. PHARMACY:

The respective regulatory bodies, including the various “Boards”  of Pharmacy, Medicine, Dentistry, Nursing, etc., clearly outline the ‘scope of practice’ for each of those disciplines. 

The orderly flow of a prescription “from” the doctor to the patient – via the Pharmacist – clearly outlines where the ‘diagnosis’ has to come from. It is statutorily the purview of the pharmacist to ‘inspect and assure’ that the drug that is being given is safe and has no known incompatibilities with the patient and its holistic environment.

It is not the purview, nor is the pharmacist trained to ‘challenge the physician’s diagnosis and verbally or otherwise with the patient. It erodes the ‘doctor-patient relationship and destroys the ‘confidence’ of the patient in their physician. At the very least, it is ‘unethical’ and may very well be a HIPPA violation and beneath the standard of care as a pharmacist. 

Any healthcare provider that is licensed to ‘prescribe’ is governed by the set of conditions and circumstances under which a prescription can be written. 

Thus it is illegal to prescribe for a person that the prescriber has not conducted the ‘chain of authority that would qualify them to write a prescription:  history and physical examination, formulation of a diagnosis, and discussing such with the patient as well as the proposed manner of treatment in a culturally sensitive and ethically appropriate manner; and provision of an opportunity for the patient to ‘question and discuss alternative forms of treatment; etc.

TO ENJOY LIFE, CAPE TOWN SOUTH AFRICA

Once the provider has met all of the aforementioned and other ‘requirements to write a prescription, then and then ONLY  should a healthcare practitioner write a prescription. Furthermore, as stated above, a pharmacist IS NOT AUTHORIZED TO WRITE A CONTROL PRESCRIPTIONS by any of the health regulatory boards.

It is my professional opinion that the pharmacist in question had ‘no reason and more importantly the pharmacist had ‘no power’ to question or interrogate each provider on ‘each prescription’ that is received as long as the ‘safety, efficacy and convenience’ of the medications being prescribed meet the standards of Medication Dispensing. 

Any given medication can be and certainly will be given for multiple different diagnoses and it is not even feasible for the pharmacist to ‘contact and question’  each and every diagnosis.

 The American Medical Association wrote on June 16, 2020:

While the AMA understands that the apparent goal of the Centers for Disease Control (CDC) Guideline was to reduce opioid prescribing, we believe the proper role of the CDC is to improve pain care. Therefore, it follows that a dedicated effort must be made to undo the damage from the misapplication of the CDC Opioid Guidelines.

We are concerned that such a careful approach to identifying the precise combination of pharmacologic options could be flagged on a prescription drug monitoring program as indications wrongly interpreted as so-called “doctor shopping” and cause the patient to be inappropriately questioned by a pharmacist.

The AMA strongly supports a pharmacist carrying out their corresponding responsibility under state and federal law. Still, the past few years are rife with examples of patients facing what amounts to interrogations at the pharmacy counter as well as denials of legitimate medication.” 

EXPOSING THE DANGEROUS DEEPLY FLAWED OPIOID POLICIES OF FEDERAL GOVERNMENT DICTATED MEDICINE: MORPHINE MILLIGRAM EQUIVALENT (MME)

Josh Bloom, ACSH’s Director of Chemical and Pharmaceutical Science:

In today’s anti-opioid climate, a “one-size-fits-all” mindset has become the foundation of government-dictated medicine. And it’s awful medicine. For example, the deeply flawed policies enacted as law all over the country are based on the “one-size-fits-none” concept of morphine milligram equivalents (MME) – the maximum amount of an opioid medication that is permitted per patient per day. 

https://www.cato.org/multimedia/cato-daily-podcast/follow-science-opioids

IN FACT, the CDC MME chart, the entire concept of morphine milligram equivalents may be convenient for bureaucrats. Still, because of differences in the absorption of different drugs into the bloodstream, half-life of different drugs, the impact of one or more other drugs on opioid levels, and large differences in the rate of metabolism caused by genetic factors are not only devoid of scientific utility but actually causes far more harm than help by creating “guidelines” that are based upon a false premise. When a policy is based on deeply flawed science, the policy itself will automatically be fatally flawed. It cannot be any other way. 

Table 1. MME equivalents. Source: CDC

While MME values are touted as useful predictors of the total “opioid load” that a patient can receive, they are nothing of the sort. And MME-based policies don’t just fail because of differences in the size of patients; they fail for multiple reasons. 

1. Flawed science yields meaningless results

Morphine is normalized to 1.0 and the conversion factor reflects the relative potency of other opioid drugs. So, if the daily MME – the maximum dose of a drug allowed – is 90 mg.

This assumption could not be less accurate. However, once we see the profound differences in the properties of the drugs and the difference between individuals who take them, it becomes clear that not only is the CDC chart flawed, but the MME is little more than a random number. 

2. Not all opioids are created equal, especially in the body

Anyone with even a passing knowledge of pharmacology would immediately be skeptical of data in the chart. Bioavailability. One of the many pharmacokinetic properties required to establish how a drug will fare within the body is called bioavailability – a critical determinant for whether a drug will be effective if taken orally.  

3. Bioavailability 

is a measure of how well a pill will be absorbed in the gut and subsequently enter the bloodstream.

4. Half-life and metabolism

Although critical, bioavailability is far from the only measure of an oral drug’s effect on people or animals is primarily metabolized by two different cytochrome P450 enzymes called 3A4 and 2D6. 

The difference in metabolizing enzymes itself is a substantial concern when comparing two different drugs, but it becomes even more so when other drugs are part of the picture. The only certainty is uncertainty.

THE COMPASSIONATE PHARMACISTS

KLICK’S PHARMACY, CAPE TOWN SOUTH AFRICA, PHARMACIST NADU

WHEN A PHARMACIST SEES HUMANITY 8,OOO MILES FROM HOME

KLICK’S PHARMACY, JOHANNESBURG, SOUTH AFRICA PHARMACIST TABO

KLICK’S PHARMACY CAPE TOWN, SOUTH AFRICA FORGOT DIABETIC MEDICATION, PHARMACIST NADU, SEPTEMBER 17, 2019

KLICK’S PHARMACY GREENMARKET SQUARE, CAPE TOWN WESTERN CAPE SOUTH AFRICA, SEPTEMBER 2019

KLICK’S PHARMACY JOHANNESBURG, SOUTH AFRICA GOT SICK, PHARMACIST TABO, ON SEPTEMBER 23, 2019

JOHANNESBURG, SOUTH AFRICA, NEEDED MEDICATION FOR DIARRHEA

PHARMACIST TABO, GRAD UNIVERSITY OF UMPOGO, COLLEGE OF PHARMACY

FOR NOW, YOU ARE WITHIN

YOUAREWITHINTHENORMS.COM , (WYNTON MARSALIS CONCERTO FOR TRUMPET AND 2 OBOES, 1984)

THE NORMS

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