Why are we sicker at a younger age?

As a community pharmacist, one of the things that you notice are trends in prescribing. Years ago, drug reps would ask the pharmacist which physicians are writing for their particular product. These days, the trends that pharmacists seem to pay attention to involve controlled substances. Which prescribers seem to write for them more often and in greater quantities. That's not what I'm going to discuss today.

Instead, I'm going to talk about something that I have observed over the last six or seven years. You see, right now I'm in my late thirties. I'm getting close to the age where chronic medical conditions have traditionally been diagnosed and people start treatment. I pay attention to what medications other people my age are taking. I compare my health with theirs. Right now, people my age are still in pretty good health.

But something that stands out to me is the medical condition of people who are younger than me. When I see the medications that people who are at least six years younger than me (we're talking the 32-and-under crowd), I am amazed.

The volume of people who are on blood pressure and cholesterol medications blows my mind. And the number of people on diabetes medications is even higher. I just saw a link to an article a couple days ago about using statins in children. ???

What is going on that has caused our younger generations to develop these chronic conditions at an early age? Well I have a theory or two about the causes. I have no data to back up these claims, it's just my observations and opinions.



Theory #1: Video games

I was in junior high when Nintendo brought out their gaming system. Super Mario and Duck Hunt were all the rage.


Ever since that system came out, video games have become the national past-time. Forget going outside to play baseball or football, we can stay inside and play it on the television and be a star. The activity level of our younger generations is virtually nothing compared to thirty years ago. Coincidentally, the 32-and-unders that I reference earlier would have just started elementary school when these systems were introduced. Our twenty-somethings have never known life without video games.

At least Mario is running around and jumping. Click here to see what would happen if Mario didn't do all of that running/jumping.



Theory #2: Fast food

I grew up in a small town in a rural area. When it was suppertime, we ate a full meal at home. McDonalds was a place that my family only saw when we were traveling on vacation. In my county, there were only a handful of fast food restaurants. For the longest time, there was only one McDonalds and one Burger King in the county that I grew up in. Both in the county seat which was 15 miles away.

During my high school years, Taco Bell moved in and another McDonalds opened up. Still, not a lot of fast food outlets. But Ronald McDonald had a trick up his sleeve. He started super-sizing the meals. What once were a large order of fries are now the small order. Sodas jumped from 21 ounces to 44 ounces. Fast forward to today. Can you drive through a town anywhere without passing at least one fast food outlet?





I stopped at a Wendy's with my daughter after preschool one day a year or so ago. There was a parent throwing a fit with the manager because her son didn't get the right toy with the kid's meal to complete the current promotion's collection. Just my opinion, but if your kid has had enough kids meals from a fast food joint to have the entire collection, you're eating fast food a bit too much. I wonder what the kid's lipid levels are.



Theory #3: Nutrient poor "food"

This ties in with the fast food a little bit, but I'm talking more about what people are buying at the grocery store. I worked at a regional grocery chain for four years. It was in an affluent community where the residents were concerned about their health. Best produce department in the county. The carts that passed in front of the pharmacy would have the produce in them, as well as a bag or two of chips, maybe some Ho-Ho's.

Contrast that to what I saw at another grocery in my county, one that has a higher proportion of customers utilizing food stamps. Do I even need to describe the items in the carts? Frozen pizzas, cases of soda (a "luxury" item), beef jerky, Doritos, Froot Loops... do I need to go on?




It was sad to see some of the younger (under 30) generation riding on the Mart-Karts because they are too fat to walk unassisted through the store. But you know what foods the carts were carrying.

I'm not going to blame Walmart for the low nutritional content of the food. It comes down to the FDA allowing food producers to distribute products with little to no nutritional content. Couple that with the food stamp programs that allow these foods to be included as covered items (luxury items) and you can see why we are getting fatter. This is just my opinion, but if the government is going to offer food assistance to people in need, let's not give them diabetes while doing so.

I went through the Express checkout at my local Giant Eagle a week or so ago in the middle of the morning. The person in front of me had three items: a bottle of Sprite, a single serving bag of Fritos, and a 24 ounce energy drink. Paid for by the Ohio Directions Card (aka food stamps). Check out the nutritional content of those items next time you are at the grocery store.

I read somewhere that your body will continue to crave food until the nutritional demands are met. That's why people can sit down and eat an entire bag of chips in a single sitting. Since the body is not getting enough nutrients, it tells you to eat more. And more. And more. Eventually the nutrient demand may be met, but it might be 3000 calories later.

I always get a kick out of this picture, but it does illustrate how your body is a reflection of the foods that you put into it.




Theory #4: Laziness/apathy

Ehhhh.... It will take too much effort to type my thoughts on this.

Besides, there's probably a medication that will take care of it. Why should I put in thirty minutes a day exercising to keep myself healthy if I can just pop a pill and chase it with a Mt Dew?

Heck, people are now to lazy to even walk their dogs.




It's sad to say, but those look like Ohio plates (my state) on that car.





Three weeks ago I put the following on Twitter:

I had a pt ask why they had to be on a med today. I wanted to say b/c you are fat, don't exercise, and won't watch what you eat.



Pretty much sums it up.

Reply to a question on Twitter

Saw this tweet from @Ron_Jordan yesterday:

If pharmacists are the most accessible medication therapy expert, what happens when so many are in Seattle for #APhA2011?


I wanted to reply with a tweet of my own, but I figured that my response would be over 140 characters. Plus you can't format tweets, at least I don't know how. So here is my response.


Total attendees at APhA 2011
- Students
- Pharmacists in industry
- Federal pharmacists
- Pharmacists working for national/state organizations
- Academics
- Hospital/clinical pharmacists
- Lobbyists
- Pharmacists in managed care
- RPhs working for publications
______________________________

appox 250-500 "accessible medication therapy experts" at APhA 2011



That's not a lot of real, accessible medication therapy experts at the convention. I would like to see a breakdown of the background of the attendees at the convention. I sent an email to the APhA last year to see if I could get that information. Never received a reply. But that's okay.

I attended the convention in Washington DC last year to attend a session on MTM. If the people sitting at my table were a cross-section of the attendees of the entire conference, then community pharmacists aren't represented real well. The folks at my table, starting across from me and moving counter-clockwise, were:

• call center pharmacist who does over-the-phone MTM
• pharmacist at a Medicare D plan learning how to implement MTM
• pharmacist at university that provides MTM to university employees
• me
• another community pharmacist
• dean of a college of pharmacy

The people at my table were amazed at what the other community pharmacist and I shared about our practice settings. They couldn't believe the issues that community pharmacists deal with on a daily basis.

Hello???

That's what a majority of pharmacists deal with every day. And that's why there are only about, by my totally unscientific calculations, about 250-500 of the most accessible medication therapy experts actually in attendance in Seattle.

The rest of us are back home enjoying a day or two off with our families/friends, trying our best to not think about pharmacy -OR- we are in the pharmacy, providing direct patient care even though we are understaffed by our employer and under-compensated by the prescription drug plans. We don't have four or five days where we can put off work to go to the conference.

We have patients to take care of.

Insights from a fellow pharmacist

The following is an email that was forwarded to me for my thoughts by a fellow pharmacist blogger. I thought that the insights were good and should be shared. I received permission from the original author to post the contents of the email here.

The email touched base on several issues that community pharmacists face. What are your thoughts?




I agree pharmacy schools have dropped the ball but they did that when they transformed pharmacy schools into MTM training schools without finding out whether or not that was a practice model that could be broadly applied to the profession. They were so desperate for a "model" of professional practice, they accepted Hepler and Strand's model without adequetly seeing if it could be accepted and applied in the real world.

Hepler and Strand in the early 1990's brought "pharmacy logic" to its ultimate conclusion. Roughly, it is that since pharmacists have the most formal "drug education" that they therefore should manage drug therapy. If you read their announcement of "pharmaceutical care" on the first page it says pharmacy should "accept" this role and on the third page, it says that nothing they propose, they believe, is or should be infringing on the practices of other health care professionals. The problem is/was doctors were doing the managing already and as we've seen since, they will decide who is to "infringe" on them and who is not. Physicians assistants and nurse practitioners (with a little battling) do much more therapy management than pharmacists. What we now call MTM is an aberration that has been modified to try to fit information available to us. We can't "manage therapy" without lab and examination information--the medical chart.

A recent 'Chain Store News" article featured a K-Mart pharmacist who is "spreading the gospel" of MTM. One of the things he has technicians do is to call doctor's offices to see if they can find out some lab values before he meets with patients to discuss their therapy. The picture of him conducting MTM was in the foot care isle. The MTM company Outcomes supposedly facilitates MTM by local pharmacists--their "training" that they refer to is one hour of learning how to bill. They also provide what they call "TIPS" (Treatment Intervention Protocol Services) to get the pharmacist to call the doctor to switch therapy to something more cost savings. Since we don't see any medical information nor the formulary, we assume they act in the patients interest. For all we know, we could be acting as drug company shills.

So, why do those recent grads have a pessimistic, unenthusiastic attitude? Perhaps they got a good look at the drive through. Maybe they realize their education isn't really going to be used. You recently wrote that you missed seeing drug reps and liked the concise information they gave--putting aside its inevitable bias toward their product. We don't see them because they now have to invest their time where it counts--with prescribers. Both the drug companies and the physicians are not going to give up therapeutic management to pharmacists. Drug companies support the PBM's and their mail-order pharmacies. They are in direct competition with us. In 2003, the government realized that drugs companies owning PBM's wasn't a good idea so they had to split--at least on paper. Why PBM's now have the right to restrict free trade and mandate using mail order pharmacies and eliminate community pharmacy from the loop makes no sense to me. I know you'd like to see all pharmacists join together but look at recent editorials in Drug Topics magazine. A Drug Topics board member and hospital pharmacist virtually told David Stanley he has no business "complaining" about retail pharmacy and the fact you have to fill 1000 Rx's a day because of squeezes by PBM reimbursements because he "chose the big dollar signs of chain pharmacy." That is a lack of understanding, empathy and unity that I find shocking and divisive. Its no way to treat a patient, much less a colleague. Its a sinister version of "blaming the victim." And I'll bet she hasn't a clue.

Not even the National Boards of Pharmacy give the pharmacist any respect. Doctors, who have the responsibility of prescribing, will be allowed to see who is getting narcotics from who and where--pharmacists will not. We are going to be left out of the information that we had hoped would propel us into an active, contributing member of the health care team. Not just regarding substance of abuse tracking and diversion but the health information that should be available to us to provide real MTM is not going to happen. If we get anything, it will be just enough to shut us up but not enough to be involved in any real decision making. Maybe I'm a pessimist--or a realist. Its hard to tell. Not long ago you wrote that all these new PharmD's coming out of school weren't going to put up with the same old crap as us old codgers had. Did you have a change of mind? Perhaps they were smart enough to see the road ahead and they realized what they were taught really didn't come close to reality. Its hard to instill pride of profession in a group when they realized that. Send a copy to the pharmacy schools who implemented an untested model of practice and get their response. Not their job, I'll bet. Just like it wasn't their job to "sell" MTM to anyone. If that's true, why would you teach it. Another thing Anna said in her response to David was, "there's no money in patient care." That is what MTM was supposed to be about--caring for the patient by a pharmacist. "Reality: Have it your way." Of course there is some truth to that, psychotics do it every day. That is one of the tests for psychoses and apparently for a divided profession. Of course, I could be wrong.