The rapacious behavior of big chain pharmacies

As a rule, the big chain pharmacies strive to increase profits by understaffing and devising performance “metrics” that must be met by pharmacists. Basically, the performance metrics amount to dispensing as many pills as they can. To sell more drugs, the pharmacists are required to call doctors and doctors’ patients—dozens a day—to persuade them to prescribe more drugs or, in the case of patients, to request additional refills. Doctors complain that pharmacies bombard them with requests for refills that patients have not asked for and should not receive. The refills are closely tracked by the pharmacy and can factor into employee bonuses. In addition, pharmacy personnel are supposed to persuade patients picking up prescriptions to sign up for automatic refills, switch from 30-day supplies to 90-day, and contact their doctor with a “proactive refill request” if a prescription was expiring or had no refills.

As to understaffing, in addition to the tasks described above, pharmacy workers are expected to give flu shots, tend the drive-through, answer phones, work the register, and counsel patients. One pharmacist said that on one day he filled 552 prescriptions—about one every minute and 25 seconds. (He quit the next day.)

Of course, plenty of mistakes are made. Here are some examples: blood pressure medicine instead of asthma medication; ear drops instead of eye drops; a chemotherapy drug instead of an anti-depressant; estrogen instead of an anti-depressant. The woman who took the chemotherapy drug died. When people sue, they’re required to sign non-disclosure agreements in order to get their settlements.

In the US, people spend more than $300 billion on prescription drugs every year. About 70 percent of of these are dispensed by chain drugstores. CVS garners a quarter of the country’s total prescription revenue and dispenses more than a billion prescriptions a year. Near as I can tell, they're the worst. Best avoid them.

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Coronavirus taxonomy and nomenclature

A virus consists of nucleic acids (DNA or RNA) enclosed in a protein coat. Because viruses can replicate only in living cells (bacteria, fungi, protozoa, plants, animals, humans) they exist in a gray area between living and nonliving.

There are a gazillion viruses living everywhere on earth. Most of these have not been identified.  Scientists identify viruses by sequencing their genomes. So far, they have identified only 6,828 species. A novel virus, such as the coronavirus that causes Covid-19, is a new strain that has not been previously identified in humans.

 Coronavirus is a family of viruses having the distinct covering of spikes (crown).

It contains 39 known species. Other coronaviruses include those that cause the common cold, “bird flu,” SARS (severe acute respiratory syndrome) and MERS (Middle Eastern respiratory syndrome).

The name of our current disease, Covid-19, stands for Coronavirus Disease 2019.

Covid-19 is caused by a virus called SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). It belongs to the same species as the virus that causes SARS (hence the name).

SARS-CoV-2 is a betacoronavirus, which means it had its origins in bats.

OK, sort of boring, but clarifying maybe?

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Worry, stress, and anxiety

Worry, stress, and anxiety are different emotions and have different effects on your body. Worry happens in your mind; stress happens in your body; anxiety happens in your mind and body.

Worry is your mind dwelling on negative thoughts, uncertain outcomes, or things that could go wrong—inability to pay the mortgage, failing a test, and so forth. It’s a way for our brains to keep us safe. Unpleasant as it is, worry stimulates our brains to take action or solve problems. However, worry is only helpful if it leads to change. It stops being functional when it leads to obsessive thoughts. If you’re stuck on obsessive thoughts, research has shown that writing down your concerns helps to calm the brain.

Stress is a physiological response to a stressor, such as a work deadline or scary medical test. It’s your body reacting to a changed situation. In prehistoric times it was a useful response to a threat, such as a nearby predator. It releases adrenaline and cortisol to help our brains and bodies deal with a threat. Today it stimulates the same behavioral response, but if the stress becomes chronic, your body stays in this fight-or-flight mode continuously, making you more prone to health problems, such as digestive issues, heart disease, and a weakening of the immune system. Research shows that exercise is a good antidote to stress, as is focusing your energy on what you can control and accepting what you can’t.

Anxiety is a sort of combination of worry and stress: its cognitive element is worry and its physiological response is like stress, but in the absence of a specific stressor. Basically, anxiety is what happens when you’re dealing with a lot of worry and a lot of stress, such as financial concerns, or relationship issues. Feeling anxious is normal, but an anxiety disorder is different. It’s a serious medical condition affecting 40 million people in the US. For normal anxiety, research has shown that wiggling your toes breaks you out of your anxiety loop.

I’m fortunate in not being particularly prone to feeling stressed or worried, even in the face of the coronavirus. Of course, like everyone else, I worry about this or that, such as whether our cat will pee on our bed tomorrow morning, something she does from time to time.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Profitable nonprofit hospitals

Seven of the 10 most profitable hospitals in America are nonprofit. Mayo Clinic, Cleveland Clinic, and Johns Hopkins fall into this category. Having a non-profit designation means the hospital is exempt from federal and local taxes. In exchange, the hospital must provide a certain amount of “community benefit.” Ideally that benefit should be charity medical care. Instead, the hospitals can qualify for the tax exemption by accepting Medicaid insurance, which, it turns out, allows them to make even greater profit.

Here’s how it works: hospitals calculate the gap between Medicaid payments and the hospital’s self-determined costs for procedures. That gap constitutes their “community benefit.” Thus, the Affordable Care Act has been a real financial boon to them. It brought millions more paying customers into the field, such that the revenue in the top seven nonprofit hospitals increased by 15 percent, while charity care—the most tangible aspect of community benefit—decreased by 35 percent.

With charitable care being optional, it stands to reason that nonprofit hospitals are often the most profitable: they don’t have to pay taxes. They also benefit from tax-free contributions from donors and tax-free bonds for capital projects. Plus they’re allowed to include training residents, fellows, and other clinical staff as community benefit. The most profitable nonprofit hospitals tend to be part of huge health care systems. Monopoly hospitals are known to charge more than non-monopoly hospitals.

The average chief executive’s package at nonprofit hospitals is worth $3.5 million annually. From 2005 to 2015 the average chief executive compensation in nonprofit hospitals increased by 93 percent. Nurses got 3 percent.

OK: While I’m at it, I’ll throw in a couple more factoids about health care: patient care generated $3.6 trillion in 2018, an amount shared by your hospital, doctor, and insurer. Also, according to the Bureau of Labor Statistics, the poorest people in this country spend 35% of their pre-tax incomes on health care and the wealthiest spend 3.5% of their income on health care, but the wealthiest spend an average of $8,720, compared to $2,119 for the poorest people. No surprise there.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.