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    Rx device instructions, IKEA-style

    David StanleyDavid StanleyI've never actually been to an IKEA store — you know, the company that built its reputation on selling affordable furniture accompanied by incomprehensible diagrams and mangled directions masquerading as assembly instructions — but I almost feel like a regular customer after my experience with the new inhaler.

    It came in our regular order, a “new and improved” version of an asthma medication that has been on the market since before I filled out my first application to pharmacy school. I knew questions would probably be coming about it, so I got online and took a look at the manufacturer's instructions for patients.

    The first words I saw were “piercing element” followed by “safety catch,” which made me wonder if I wasn't in for more danger than I bargained for. I kept going, though, and noticed a helpful acronym that promised to make the dosing steps easy to remember, the same type of trick I used in college to try to get complex and/or long lists of information to stick to my brain.

    There were four pages of patient instructions on the company's website, and at first glance only two things were immediately clear: the part of the diagram labeled “white arrows,” and the fact that I should not keep this inhaler in the freezer. I thought to myself, “How is an elderly patient, let's say with vision problems, supposed to figure this thing out so he can breathe?” 

    Then I remembered. The patient would be counting on me. My next thought was something I never thought I would ever say: “I wish there was a sales rep for this thing around here.”

    See also: Birth control and med adherence are connected how?

    Remember the detailers?

    It wasn't that long ago that educating healthcare professionals about their products could be described as a primary mission of pharmaceutical sales representatives. Somewhere along the way, that seems to have slipped away, at least from my perspective behind the pharmacy counter. 

    A few years ago, a sales rep I was friendly with stopped by the store to give me an old-fashioned, full-scale presentation about her product, just for the heck of it. As she spoke, I was struck by how long it had been since I'd had an encounter like this. By the time I left the chain-store world, it seemed as if, in the eyes of a drug company's sales force, pharmacies were only useful as dropping-off points for co-pay coupons destined for the landfill.

    I never would have admitted it at the time, but looking back, I now understand the value of a good sales representative — and as I read the instruction to be careful not to touch the piercing element of this new inhaler while pressing the safety catch, I suddenly missed them.

    See also: When lawmakers prescribe

    David Stanley, RPh
    David Stanley is a pharmacy owner, blogger, and professional writer in northern California. Contact him at [email protected]

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    • Anonymous
      Tsk, tsk, we pharmacists should not be 'leaving it up' to our patients to figure things out! Some healthcare organizations forbid pharmaceutical sales representative on the premises, but I suspect that it is part of a physician lobby effort. Sure, I had my favorite pens and a counting tray or two. Some worked. Some did not. I don't remember which was which, but I do remember trying to figure out how an nasal insulin inhaler worked and how to measure doses, and wondering how to prepare a chemo drug with strict instructions that did not at all seem intuitive (adding a certain amount of diluent to achieve a concentration that did not match the drug amount on the vial label). I feel it is demeaning for the docs to prohibit drug reps yet when they ask us about a drug, or more seriously, yet, a patient asks about a brand new product (not in the trade journals), and I have to play 20 questions to figure out what I need to find out for that person. . On the other side of the coin, the level of knowledge (deficit!) of our patients and the healthcare-literacy they possess is shockingly low. In just an ordinary passing conversation in a coffee-shop with a person who had been a dental hygienist years ago, aghast that our town has fluorinated drinking water. She was truly REMORSEFUL that she applied fluoride paste to the teeth of children. Huh? Where was I when someone decided fluoride was bad for kids? . There are people convinced a flu shot causes flu in normal healthy immunocompetent people. In my area of the country, women go to term without a lick of prenatal care. Then, there's that whole heroin/HIV epidemic thing. As a pharmacist, it freaks me out people freely stick dirty needles in their bloodstream. They've never seen the ad illustrating germ content of a sneeze? . Then, there's that camp that thinks legalization of marijuana is necessary based on its use in relieving pain. Give me a break. Legalization is in the interest of people that want to possess it and for the major part wish to consume it for recreational purposes. And, if not, then for its placebo effect. Right? . People go around refusing entirely appropriate therapy, with their uninformed castigation of drug companies for money-lust, when there is a simple basic reason for R&D. But, mix that lack of knowledge with outtasight drug pricing and outtasync reimbursement with reality. . I couldn't believe I heard an NPR interviewer accept the argument that naloxone should be expensive. C'mon. One supplier? There ought to be a law that drug companies can't close down, or close up shop without ensuring more than one supplier. So what if there'll be another manufacturer (naloxone) in a few years? Why do we think it is acceptable the drug still can cost an arm and a leg? Why do know-nothing politicians believe the cock-and-bull story about how expensive it is to provide naloxone, period? Then, there's the rationale... well, they can charge $300 and insurance will pick up the costs. Crimminy. Is NOT that one of the basic tenets of the ACA, that insurance costs will be contained--if for no other reason, that bloating costs is NOT fair? . Are we or aren't we the drug experts? Who is telling the politicians the truth of the matter? Do we pharmacists know why, and why do we accept it? ' Anyway, I predict a reversal of the old anti-drug rep stance within the next five years. Five year, max. (That is, if 'they' let a decent pharmacist tell the public what is going on.)