JP at large: It's my job, man

I was questioned by a doctor when he prescribed Bextra (valdecoxib, Pfizer). It was just days after Vioxx (rofecoxib, Merck) had been withdrawn from the market. I told his patient that Bextra and Vioxx were members of the same family.

The doctor was not happy. "Why did you tell my patient that Bextra was as dangerous as Vioxx?"

"I did not tell him that," I said. I explained that I had told his patient Vioxx had been withdrawn from the market. I told him why and I told him that Bextra was in the same category of drug. "I thought your patient should make an informed decision as to whether he wanted to take Bextra or not," I added.

"It is my job," I said. "I am required by law to counsel your patients on their drug use."

"Well, I don't like it," he harrumphed. "This patient should be on Bextra, and he won't take it now. He insists some natural stuff called MSM has taken away his pain." He hung up with a grumpy goodbye. Well, we all know what happened to Bextra. I was just relieved the doctor didn't ask me who recommended the MSM.

Last fall, I attended a CE course presented by Paul Garbarini, an R.Ph. who is also an attorney. He called his presentation: Liability in the Expanded Practice of Pharmacy. He talked for an hour, but I got my money's worth in the first five minutes when he made a point convincingly. Pharmacists have a duty to warn. Simple, clear, and obvious. The next part of his message was unambiguous. If you don't warn, it could be your ass.

The case studies Garbarini presented were scarier than hell. Pharmacists went down and they went down hard. In each case their culpability was uncomplicated and straightforward. They failed to warn their patients about dangers of their drug therapy. Many of our employers advertise that their R.Ph.s are watching out for drug dangers. If we fail to warn, a court could say that we have not kept a promise made by our company.

All of us warn of drowsiness with opiates. We tell patients their ability to drive may be impaired. Have you ever tried warning a guy who's used benzodiazepines for years that he may experience some rough symptoms if he tries to quit? I did. Once. The crisis that caused him to need clonazepam had been over years before. I had this naive idea that he might want to quit. He pretty much told me to mind my own business.

We essentially have an opportunity to warn with almost every single prescription. Where do we draw the line? There is just not enough time in the day to warn every patient about everything. We are forced to pick and choose. A sticky situation, huh?

Last week, I saw the Bextra patient when he bought a new supply of MSM. He held up the New York Times front page and pointed at the prominent Bextra article. No words were needed. We both just smiled.

The author is a community pharmacist. He lives in Stowe,Vt. Please e-mail him at jpgakis@hotmail.com
and send a copy to us at drugtopics@advanstar.com
. Also check out his new Web site at http://jimplagakis.com/.