When the “experts” are called upon to provide commentary in professional Journals, it would help if they research their work sufficiently to write something accurate and useful.

Michael Gabay, Pharm D, JD, BCPS, has attempted to present the topic of Pharmacists conscience clauses, which have led to legislation excusing pharmacists from dispensing drugs which may operate to kill a human organism.

Listed below are a few of the troubles with Gabay’s article:

1) The implication that RU-486 contributed to pharmacists’ conscientious objection conflicts. Mifepristone/misoprostil regimen was highly regulated, and dispensed by the abortion practitioners themselves, rather than pharmacists. The article gives no mention of ulipristal acetate, the new analog of mifepristone which is now approved as a morning after pill, doses of which may be accumulated to accomplish a later abortion. (Way to keep current, Dr. Gabay.)

2) Glaring omissions of significant, current, judicial decisions. Dr. Gabay is a Clinical Associate Professor in the Dept. of Pharmacy Practice, University of Illinois, Chicago. Yes, he is in Illinois, a member of the Chicago Bar Association, and inactive member of the Illinois Bar. His article failed to mention the group of lawsuits recently decided in his own state, involving conscientiously objecting pharmacists and pharmacy owners, Walgreens and former Gov. Blagojevich. It is possible that Dr. Gabay, JD, was not aware of these significant court decisions, or perhaps he did not approve of them.

3) Garbled facts of the K Mart controversy, which actually involved a refusal to dispense progestin-only birth control drugs, not all “oral contraceptives” as the article incorrectly states.

4) Attributing the statement that oral contraceptives can prevent “implantation of a fertilized ovum”, to a person who knew better than that. Embryology lesson begins here: Fertilization of the secondary oocyte, produces an evanescent form called the zygote, that immediately begins cellular division, and proceeds to the next stage. By the time the human organism reaches the uterus to begin implantation, its embryonic form has differentiated into a blastocyst. (Dr. Gabay forgot the basic anatomy/physiology stuff which should have been prerequisite to his Pharm D.)

5) Dr. Gabay still appears not to know what Ms. Brauer knew about the mechanisms of birth control drugs, and the progestin, norethindrone, in particular. The actual disagreement in the K Mart case is still readily visible on the net: Page 1 and Page 2.

6) The crux of ethical objection to dispensing drugs which act, to a significant extent, to stop the life of a human organism is just that. It is not tied up in the various newer concepts of “abortion” and “pregnancy” which exclude the early human embryo. Abusing these terms to obfuscate the issue violates the patients’ right to give informed consent. The law has established no cogent or consistent basis for determining which human organisms may be willfully killed and which may not.

The complimentary review and editorializing will end here, to prevent reader fatigue.

The take home lesson for users of the literature in science and medicine is to read critically. Much of it is incomplete and factually “challenged” whether it is primary literature, or review and commentary, as in the case of Dr. Gabay’s article.

The value of extensive, formal education (as currently supplied) is also called into question, as it increasingly appears not to be helping with the quality of intellectual output.

*Note: This commentary has not been subjected to editorial review.

Idaho Pharmacist Refused to Dispense Planned Parenthood Prescription Cleared of Wrongdoing

February 2, 2011February 3, 2011 ~ Pharmer

Planned Parenthood continues its harassment of an Idaho Pharmacist who refused to dispense an order for methergine, nor give a referral.

The media, acting as mouthpiece for Planned Parenthood’s version of the story gives the following outline.

The pharmacist took a call from planned parenthood about an order for methergine (which is used to stem bleeding after delivery, miscarriage, abortion). The pharmacist is said to have asked if this was related to an abortion procedure. The planned parenthood nurse would not answer, citing the privacy of the patient.
The pharmacist allegedly refused to take the order, and also did not refer the nurse to another pharmacy. She is said to have hung up the phone on planned parenthood. (smile). And ask yourself why planned parenthood is doing abortions without this hemostatic drug on the premises. Isn’t that dangerous?

We do not have the pharmacist’s version of the story. We do have the people at Second Hand Smoke weighing in on this case, and pondering whether the pharmacist did the right thing, and was within the scope of Idaho pharmacy practice standards. As many of them had insufficient data and background to address this topic, Pharmer was only too happy to assist them in their cogitations as follows:

Someone thinks that oral methergine is going to sufficiently address the kind of uncontrolled bleeding that can kill a patient in minutes.

Another person thinks that pharmacists should not have the patient’s medical history.

Without information as to what is being treated, the pharmacist can’t check the safety and appropriateness of the prescription. Under these conditions, the prescription should not be filled.

There are some people who should avoid health care practice due to incompetence.

At my place of employment I correct numerous physician orders each shift. This is a necessary part of my job function as a pharmacist. I also tell the physicians and nurses how to use the meds (to avoid these errors). When I was a retail pharmacist, I obtained changes in prescriptions on a regular basis. I refused to fill some prescriptions due to dangerous drug interactions, etc. I refused to stock and dispense Redux, which is now off the market, because I knew better than the FDA, at the time, that taking this drug was not worth the risk.

The pharmacist in this case was correct to refuse a prescription from a prescriber who was unwilling to verify that the prescription was within the scope of his or her practice. Pharmacists need that information to know if the prescription is legitimate and “legal to dispense”. In addition, prescriptions from Planned Parenthood should be scrutinized to see if they really have been authorized by a licensed prescriber. It appears from the story that the Planned Parenthood agent was not being cooperative with respect to providing information relevant to the prescription, and the pharmacist may have had good legal and clinical reason to avoid taking the order. Not much is really known about this case since the info is coming mainly from planned parenthood, and its media mouthpiece.

If a woman came to me AFTER the fact with a prescription for methergine, I would fill it, (and have done that in retail practice). At that time, the drug is not a part of the abortion procedure.

I would not fill a prescription which could be preliminary or a part of the actual abortion regimen.

With the availability of Ella, (ulipristal acetate) which operates in the same way as RU-486- (mifepristone), there will be many related conundrums for hospitals which don’t normally do abortions. Ulipristal at 0.5mg/kg is used as a morning after pill. The doses can be combined to use for later chemical abortions. Expect many “miscarraiges”, “missed ABs”, D&Cs to be followed up at legitimate hospitals after the woman has used ulipristal to kill her baby in the embryonic stage of development. This is a significant reason for bringing Ella to market as a morning after pill: to allow its “off label” use and finish up chemical abortions at legitimate facilities, thus dodging much of the stigma and personal $ cost associated with abortion. It is also a means to deal with the decreasing supply of abortionists.

The Idaho board has ruled that the pharmacist broke no state laws in alleged refusal to fill the prescription.

Planned Parenthood continues to harass the pharmacist by threatening to file a complaint with federal agencies. This is not likely to go anywhere, as this part of pharmacy practice is governed by state law.

Planned Parenthood also stuck its nose in the business of the Pharmer by intervening in an employment issue in which it had no legal standing. This organization has a long history of using your tax money (which accounts for at least a third of its income) to harass pro-life health care professionals in many different states.

Planned Parenthood has, for many years been involved in canvassing operations to locate pro-life pharmacists. Pharmer has received calls to this end, and told the callers to do their own research. Planned parenthood has sent people to “sting” CPCs and pro-life health care professionals. For us, there is poetic justice in seeing the work of LiveAction.org, and seeing it reveal publicly what we’ve heard all along from their dissatisfied clientele.

*Compare the Planned Parenthood complaint to the Idaho Pharmacy Board with the media feed on this issue. Hook- Line and Sinker.

Pharmacists interventions in health care

January 15, 2011January 24, 2011 ~ Pharmer

There’s an interesting and confused article called Pharmacy Wars, which should be read in order to understand the reason for posting this article.

A conscience clause is not “a pharmacists right to deny service based upon his personal belief”.
There are many kinds of conscience clauses contained in law which may excuse various medical professionals from involvement in participating in the act of killing a human. Such a thing is attached to the law allowing medically assisted suicide in Oregon. Pharmacists are not required to dispense medication for that purpose, for example. A very few states have laws which excuse pharmacists from dispensing drugs which kill humans very early in development. In most areas, pharmacists will refuse to dispense for that purpose based upon long standing legal protection of religious freedom and conscientious objection to killing. There have been some requirements for signage to be placed at pharmacies in which the pharmacist has a conscientious objection to killing, which are not related to any new legal protections of the human right not to willfully kill others.

I am eager to hear of any specific cases in which a pharmacist refused to dispense life saving medication citing the laws which protect him from being forced to help kill another human. The laws are actually unrelated to this. I have heard of none thus far. The author of this article appears to know of such things and can perhaps provide the references.

HIV patients tend to gravitate towards specialized pharmacists for treatment, as their problems are complex, and the anti-retrovirals have many drug and food interactions which must be juggled for the patient’s safety. Pharmacists in some states are required to take continuing ed in this topic, but it is really a subspecialty of pharmacy as is oncology, for example.

It is not the pharmaceutical industry, but rather academia and state and federal law which influenced the placement of pharmacists more prominently between the physician and patient. Pharmacists are educated that they are morally, civilly or even criminally liable for not addressing safety hazards of medication therapy and stopping medication errors.

A non-traditional Pharm D is not a bachelors degree. It requires graduate education after obtaining the pharmacy degree and license. Non traditional means that it is likely done partially on-line, partially in the classroom and with a different array of experience to make up the clinical requirement.

If one medical professional trashes another medical professional when speaking to a patient, he runs the risk of legal reprisal for anything said which is not completely accurate. He also runs the risk of violating the privacy of other patients.

The standards of safety regarding any drug, and the legal requirements for prescribing and dispensing it can be altered at any time, and when pharmacists become aware of it, they often have to give the patients and the physicians the bad news. This is usually greeted with resentment.

One recent example is the sudden removal of propoxyphine/acetaminophen from the market based upon 53 years of aftermarket experience. It has been decided that the drug bears too much risk for causing cardiac arrhythmia relative to its rather modest potential for pain relief. Some physicians were not at all pleased to hear this news, and might have had a temper tantrum similar to the one to which the author above alludes.

The article, Pharmacy Wars, is filled with so many inaccuracies regarding the function of pharmacists, and the driving forces behind them, that one wonders about the accuracy of the story regarding the pharmacists interaction with the physician.

I do not frequent the subversify blog, but was directed there to append some pertinent information to an article which misrepresented the purpose and function of existing conscience laws.