Don't you just love calling a company and getting a machine? I realize that it is a sign of the times (and we use them at our office also) but I am not talking about the relatively simple answering/interactive machines where you simply input a response once or twice to get to the person to whom you wish to speak. I'm talking about the "customer service" telephone numbers that are anything but customer service.

In a recent issue of "Bottom-Line Personal" I am using for this editorial, it was stated that nearly 40% of all phone calls to customer service operations are handled by interactive voice response (IVR) systems. These IVR systems take you through the annoying, time-consuming question and answer series of key-punch menus. It's interesting that they start off with the statement, "So we can better serve you, please press or say one, two, three, four, five, etc." How many can you remember? So you press the number that repeats the whole thing again. I have actually been on calls for 45 minutes and still have not made contact with a "person"; thank goodness for wireless earpieces so you can still work while calling. The following are just a few of the "shortcuts" that have been published to help navigate and bypass the maze.

Cell Phone Service Providers:

• Cellular One (888-910-9191), press 4.
• Sprint/Nextel (800-639-6111), keep pressing 0.
• Verizon Wireless (800-922-0204), enter your cell phone number, then 0, then 4.

Computer Companies:

• Apple (800-275-2273), after menu choices, say "operator" after each prompt.
• Hewlett-Packard (800-474-6836), keep saying "agent" at each prompt.

Credit Card Companies:

• American Express (800-528-4800), keep pressing 0# and ignore the prompts that say they don't recognize your input.
• Capital One (800-867-0904), keep pressing 0. Ignore prompts.
• Citibank Citicards (800-940-5114), keep pressing #. Ignore prompts.
• MasterCard (800-622-7747), keep pressing 0.
• Visa (800-847-2911, keep pressing 0. Ignore prompts.

Insurance Companies:

• Aetna (800-680-3566), press *, then at each prompt, press 0. Ignore prompts.
• AIG (713-522-1111), A HUMAN answers!
• Ameritas (800-745-1112), keep pressing 0.
• Medicare (800-633-4227), say "agent" after the opening prompt.
• State Farm (800-447-4930, press 00, then ##.

Mail, Package Delivery:

• FEDEX (888-463-3339), keep saying "rep". Ignore prompts.
• UPS (800-742-5877), keep saying "agent".
• US Postal Service (800-275-8777), keep pressing 0 at the voice prompts.

There are quite a number of additional shortcuts but we will stop here for now. These should work, but if they don't, at least you have something to do while you are online. If you have one not listed here, please e-mail it to me at lallen@ijpc.com and we can compile a list and make it available for pharmacists to access.

On the other side, if we had real people answering the calls, would it be any better? How often do you go shopping and ask the clerk about something and they don't know the answer (and sometimes don't even care!). Same thing often happens during telephone inquiries. So, maybe, the IVR systems might be best, if you use the shortcuts here. Actually, in many cases, when I do get through to the "correct person", I obtain the information or answer I need. I guess we also need to ask the question, "If I have an IVR in my store, how user-friendly is it?"

Loyd V. Allen, Jr., Ph.D., R.Ph
Editor-in-Chief

The FDA has decided that it will exempt most investigational drugs and biologics used in phase 1 clinical trials from its current good manufacturing practice (CGMP) regulations. This is now supportive of more compounding facilities becoming involved in preparing drug preparations for clinical trials.

As Janet Woodcock, FDA's deputy commissioner for operations, said Jan. 12 during a press briefing on the new rule and companion guidance documents, "The FDA has had long-standing regulations on GMPs. The problem was that our GMP regs had a one-size-fits-all approach to manufacturing...The regs are not appropriate - really didn't fit - laboratory production. So because we've issued a new direct final rule, this allows the FDA for the first time to give direction and advice to researchers on actually how to safely prepare and produce the small quantities of compound in the laboratory that can then be used in people."

For more information, go to: http://www.thompson.com/hp_newsbriefs/060112a_fooddrug.html

If you find yourself telling patients multiple times a day that you don't accept insurance for compounds....you need CompoundingToday.com's Insurance Sign. Click HERE to access this great time-saving tool.

You can download this form for future use and make color copies for display in your store as needed.

One more time and money-saving tool from CompoundingToday.com.

Here is a list of all the information that has been added to CompoundingToday.com in the last few months:

New Features

• Tonicity Adjustment Tool
• Disinfectants Tool
• Preservatives and Antioxidants Tool
• Book Reviews Section
• Keyword Search for SOPs

Citations and Abstracts

• Shortness of Breath (42)
• Treatment of Cancer Pain (47)
• Pallitive Cancer Care (33)
• Various Cancer Care Topics (27)
• Treatment of Osteoarthritis (32)
• Sports Medicine and Musculoskeletal Injuries (35)
• Compatibility and Stability Articles (33)
• Urogenital and Sexual Disorders in Menopausal Women (31)
• Endocrine Disorders in Premenopausal Women (34)
• Urogenital and Sexual Disorders in Menopausal Women (28)
• HRT and Blood Coagulation/Clots (10)

SOPs

• Talc USP Suppliers
• Use of Brass Sieve
• Corning Model 430 and 445 pH Meters

Book reviews

• The Road to Immunity : How To Survive and Thrive in a Toxic World
• The Germ Freak�s Guide to Outwitting Colds and Flu
• Bag the Elephant! How to Win & Keep BIG Customers
• Overcoming Arthritis by David Brownstein, M.D.
• Salt: Your Way to Health

Newsletters

• "Specials" are not "Sale" Items in UK Pharmacies, Part II
• "Specials" are not "Sale" Items in UK Pharmacies, Part 1
• Where are the "statesmen"?
• Happy New Year!
• Merry Christmas!
• FDA and HHS National Leaders Support Individualized Medications!
• Acacia is Not Just Used in Drugs?
• Unapproved Drugs, What's the big deal?
• Newsletter - Orphan Drugs: Part I

This week citations and abstracts on the topic of palliation of dyspnea with a focus on nebulized opioids were added to the literature search database. See the list of all 42 articles at http://www.CompoundingToday.com/Articles/SearchResult.cfm?Batch=42. Here are a few samples of those articles:

• Brown SJ, Eichner SF, Jones JR. Nebulized morphine for relief of dyspnea due to chronic lung disease. Ann Pharmacother 2005; 39(6): 1088-1092.
• Bruera E, Sala R, Spruyt O et al. Nebulized versus subcutaneous morphine for patients with cancer dyspnea: A preliminary study. J Pain Symptom Manage 2005; 29(6): 613-618.
• Cohen SP, Dawson TC. Nebulized morphine as a treatment for dyspnea in a child with cystic fibrosis. Pediatrics 2002; 110(3): e38.
• Coyne PJ, Viswanathan R, Smith TJ. Nebulized fentanyl citrate improves patients' perception of breathing, respiratory rate, and oxygen saturation in dyspnea. J Pain Symptom Manage 2002; 23 (2): 157-160.
• Ferraresi V. Inhaled opioids for the treatment of dyspnea. Am J Health Syst Pharm 2005; 62(3): 319-320.

Becoming More Efficient in Compounding
Do you routinely use a certain chemical, such as methylparaben, and would like to be able to obtain a certain quantity faster and more accurately for incorporation into a liquid or semisolid dosage form? Why not make a dilution, or aliquot, of it in propylene glycol; then, all that is required is to measure the volume of the solution and add it to the formula. For example, if you make a 1% methylparaben in propylene glycol, it will contain 10 mg/mL; a 10% methylparaben in propylene glycol will contain 100 mg/mL, etc. In each of these two cases, to obtain 150 mg, you would use 15 mL of the first solution, OR you could use 1.5 mL of the second solution. These "concentrates" must be carefully labeled, dated, etc. and personnel thoroughly trained in their use. They can lead to more efficient compounding activities.