Tuesday, November 11, 2003

I'm rarely shocked by innumeracy these days, but be forewarned that this one was a jaw-dropper for both Rick and me.

I have a sporadically recurring health problem that is not serious, not contagious, and not something for which I miss work, but it definitely qualifies as a severe nuisance when it decides to flare up. Fortunately, there's a very effective treatment for it, which happens to require a non-standard preparation of a common prescription drug. Because this preparation is not a pre-packaged product, it can be prepared only by a compounding pharmacist.

Those of you who are over 35 or so may remember when all pharmacies were compounding pharmacies. When I was a kid, and I came down with one of my legendary house-rattling coughs, our family doctor would write out a script for a custom-blended cough syrup that contained, as far as I know, a hefty dosage of antihistamines along with just enough codeine to tie the whole thing together. (Oh, and I think it was flavored with cherry mint hydrazine nuclear waste. In order to willingly abuse this drug, you'd need taste buds of Teflon-coated tungsten.) Any one of the pharmacies in town could whip up this concoction, which when taken by a coughing child allowed the entire family to get some sleep without fearing a lethal shower of fallen rafters. This is not the kind of thing, however, that most modern chain pharmacies are willing to do, although some will perform minimal feats of compounding when absolutely necessary.

So, Rick called the drugstore chain nearest to our house, described what was needed, and asked if the pharmacist on duty could prepare it. At first, the pharmacist said yes, although it wouldn't be ready for one and a half days. However, this same pharmacist phoned Rick back a few minutes later and said that he couldn't compound the prescription after all. When Rick asked why, the pharmacist answered, "We buy this drug at a 2% concentration. I wouldn't even know how to make the 0.4% concentration."

(Pry mandible loose from linoleum, stammer, terminate conversation ASAP.)

The good news is that we found an actual compounding pharmacy about 10 miles from our house. They filled the script seven hours after it was called in. They only charged two-thirds of their original estimate for it. It worked. For the most part, I feel much better now. Of course, I'm also reflecting on the phenomenon of a chain-drugstore pharmacist who doesn't know how to make a four-to-one dilution. I said I felt better. I didn't say I felt good.


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